WO2020146177A2 - Procédé d'ajustement d'une profondeur étendue mixte de lentille ajustable par la lumiere à axes décalés latéralement - Google Patents

Procédé d'ajustement d'une profondeur étendue mixte de lentille ajustable par la lumiere à axes décalés latéralement Download PDF

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Publication number
WO2020146177A2
WO2020146177A2 PCT/US2019/069170 US2019069170W WO2020146177A2 WO 2020146177 A2 WO2020146177 A2 WO 2020146177A2 US 2019069170 W US2019069170 W US 2019069170W WO 2020146177 A2 WO2020146177 A2 WO 2020146177A2
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Prior art keywords
lal
optical power
central
axis
illumination
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PCT/US2019/069170
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English (en)
Inventor
Ilya Goldshleger
John Kondis
Matt Haller
Christian A SANDSTEDT
Pablo Artal
Eloy Angel VILLEGAS
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Rxsight, Inc.
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Priority claimed from US16/236,659 external-priority patent/US11135052B2/en
Application filed by Rxsight, Inc. filed Critical Rxsight, Inc.
Publication of WO2020146177A2 publication Critical patent/WO2020146177A2/fr

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  • the field of the invention includes at least medical and surgical instruments; treatment devices; surgery and surgical supplies; and. medicine.
  • the field of subject matter of the invention includes ophthalmology.
  • the disclosure relates to optical elements, which can be modified post-manufacture such that different versions of the element will have different optical properties.
  • the disclosure relates to lenses, such as intraocular lenses, which can be converted into aspheric lenses post-fabrication.
  • This invention relates to fight adjustable lenses with a depth of focus, and more specifically to blended extended depth of focus light adjustable lenses and to the methods of adjusting these lenses by illumination.
  • An intraocular lens is a surgically implanted, polymeric lens designed to replace the natural crystalline lens in the human eye, typically in patients who have developed visually significant cataracts. Since their inception in the late 1940’s, lOLs have provided improved uncorrected visual acuity (UCVA) compared to that of the eataractous or aphakic state; however, problems in predictably achieving emmetropia persist as most post-cataract surgery patients rely on spectacles or contact lenses for optimal distance vision. Compounding the issues related to achieving optimum distance vision, patients undergoing cataract surgery lose their ability to accommodate, i.e. the ability to see objects at both near and distance.
  • UCVA uncorrected visual acuity
  • IOL power required for a particular post-operative refraction is dependent on the axial length of the eye, the optical power of the cornea, and the predicted location of the IOL within the eye. Accurate calculation of IOL power is difficult because the determination of axial length, corneal curvature, and the predicted position of the IOL in the eye is inherently inaccurate. (Narvaez et al , 2006; Olsen, 1992; Preussner et al., 2004; Murphy et al., 2002). Surgically induced cylinder and variable lens position following implantation will create refractive errors, even if preoperative measurements were completely accurate.
  • Accommodation refers to the ability of a person to use their unassisted ocular structure to view objects at both near (e.g. reading) and far (e.g. driving) distances.
  • the mechanism whereby humans accommodate is by contraction and relaxation of the ciliary body, which connects onto the capsular bag surrounding the natural lens. Under the application of ciliary stress, the human lens will undergo a shape change effectively altering the radius of curvature of the lens. (Ciuffreda, 1998). This action produces a concomitant change in the power of the lens.
  • presbyopia is known as presbyopia and currently affects more than 90 million people in the United States.
  • the patient can be implanted with a multifocal IOL.
  • multifocal lOLs currently sold in the United States are the ReZoom* (Abbott Medical Optics, Santa Ana, CA) and ReStor* (Alcon, Fort Worth, TX) lenses.
  • the ReZoom ® lens is comprised of five concentric, aspheric refractive zones. (U.S. Patent No. 5,225,858). Each zone is a multifocal element and thus pupil size should play little or no role in determining final image quality. However, the pupil size must be greater than 2.5 mm to be able to experience the multifocal effect.
  • Image contrast is sacrificed at the near and far distances, to achieve the intermediate and has an associated loss equivalent to one line of visual acuity.
  • the ReStor ® lenses both the 3.0 and 4.0 versions, provide simultaneous near and distance vision by a series of concentric, apodized diffractive rings in the central, three millimeter diameter of the lenses.
  • the mechanism of diffractive optics should minimize the problems associated with variable pupil sizes and small amounts of decentration.
  • the acceptance and implantation of both of these lenses has been limited by the difficulty experienced with glares, rings, halos, monocular diplopia, and the contraindication for patients with an astigmatism of greater than or equal to 2.0 D.
  • AKKOMMODATIVE ® ICU is similar in design, but possesses four hinged haptics attached to the edge of the optic.
  • the accommodative effect of these lenses is caused by the vaulting of the plate IOL by the contraction of the ciliary body. This vaulting may be a response of the ciliary body contraction directly or caused by the associated anterior displacement of the vitreous body.
  • This type of lens can be designed in-vivo to correct to an initial emmetropic state (light from infinity forming a perfect focus on the retina) and then the presbyopia correction is added during a second treatment.
  • Such a lens would (1) remove the guess work involved in presurgical power selection, (2) overcome the wound healing response inherent to IOL implantation, and (3) allow the amount of near vision to be customized to correspond to the patient's requirements.
  • an intraocular lens which is adjusted post operatively in-vivo to form an aspheric optical element would result in the patient having an increased depth of focus (DOF), which allows the patient to see both distance and near (e.g. 40 cm) through the same lens.
  • DOE depth of focus
  • a new technique has been developed recently to correct or mitigate such postsurgical IOL shift or tilt.
  • This new technique is capable of adjusting the optical properties of the lOLs with a postsurgical procedure to compensate the shift or tilt of the IOL.
  • the IOLs can be fabricated from a photo- polyinerizable material, henceforth making them Light Adjustable Lenses, or LALs.
  • the implanted LALs may shift and tilt, eventually settling into a postsurgical position different from what the surgeon planned.
  • a Light Delivery System can be used to illuminate the LALs with an illumination pattern that induces a change in the refractive properties of the LALs, such that their optical performance is modified to compensate the unintended postsurgical shift or tilt of the LAL.
  • Some existing lOLs have a radially varying optical power. Their optical performance is characterized by an extended depth of focus (EDOF), and thereby can be helpful to mitigate presbyopia in patients. Some of these EDOF lOLs are pre-formed before implantation. Alternatively, the radially varying optical power can be induced by applying a radially varying illumination pattern after the LAL was implanted and then settled, as described elsewhere in this document. While the medical benefit of the EDOF IOLs is substantial, the effective optical power of these EDOF lOLs varies with the radius of the pupil of the eye.
  • EDOF extended depth of focus
  • EDOF lOLs/LALs have an extended focal region instead of a sharply defined focal point, the image they create on the retina is experienced by some patients as having some aberrations, being somewhat blurry.
  • IOLs Another class of presbyopia-mitigating IOLs has been described in the commonly owned US patent 7,281,795, to Sandstedt et al., entitled:“Light adjustable multifocal lenses”, hereby incorporated by reference in its entirety.
  • This class of IOLs have a central region with a central optical power and corresponding central focal point, and a peripheral region with a peripheral optical power and corresponding peripheral focal point. Accordingly, these are sometimes referred to as multifocal IOLs.
  • the central region is formed for near vision and the peripheral region for distance vision. Accordingly, the central optical power is typically 1-3 diopters stronger than the peripheral optical power.
  • the central region is sometimes referred to as a“Central Near Add” (CNA) region.
  • CNA Central Near Add
  • multifocal IOLs can also be either pro-formed prior to the surgery, or can be formed post-surgically, by applying an appropriate illumination pattern to an implanted LAL.
  • CNA, or multifocal lOLs have the potential to mitigate presbyopia similarly to multifocal contact lenses.
  • One of the medical benefits of these multifocal lenses is that their focal points are well-defined. Therefore, the images they form at the focal points have only small aberrations.
  • one of the challenges of multifocal IOLs is that the visual acuity strongly depends on how precisely the CNA region is aligned with the visual axis of the eye. Even a small decentering of the small CNA region can induce various aberrations and astigmatism, most notably coma, and thus can cause a substantial deterioration of the visual acuity.
  • the CNA region is typically quite small, and the implanted multifocal lOLs also tend to shift and tilt, the visual acuity of the pre-formed multifocal IOLs often deteriorates as they shift and de-center after implantation.
  • the central region is formed prior to implantation, such as molded into an IOL, or into a LAL
  • the postsurgical shifts of the lOL/LAL can lead to a correspondingly decentered central region.
  • the central region is formed after the implantation by illuminating the LAL with a suitable illumination pattern
  • another issue can lead to the same problem.
  • the LALs are illuminated after the iris of the eye is substantially dilated, in order to accommodate the entire illumination pattern.
  • the illumination pattern to form the CN A region can be centered on the geometric axis of the LAL. Less typically, the illumination pattern can be centered on the dilated iris.
  • the iris often returns to its natural, non-dilated state non-symmetrically, thus shifting the visual axis of the eye.
  • the CNA region that was centered either on the geometric LAL axis, or on the dilated iris may end up being notably decentered from the visual axis of the eye, defined by the non-dilated iris.
  • General embodiments of the present invention provide a first optical element whose properties may be adjusted post-manufacture to produce a second optical element, wherein the second optical element is capable of providing an increased depth of focus to a patient.
  • the invention relates to a spherical intraocular lens that is capable of being transformed post-operatively into an aspheric optical element.
  • the intraocular and/or focal zones of the aspheric optical element can be more precisely adjusted after the lens has been subjected to any post-operative migration.
  • the adjustment of the aspheric optical element can be based on input from the patient and/or the adjustment of the aspheric optical element can be accomplished through standard refraction techniques rather titan making the adjustment through preoperative estimation.
  • he alteration of the spherical lOL is accomplished via a modifying composition (“MC”) dispersed throughout the spherical IOL.
  • the MC is capable of polymerization when exposed to an external stimulus such as heat or light.
  • the stimulus can be directed to one or more regions of the element causing polymerization of the MC only in the exposed regions.
  • the polymerization of the MC causes changes in the optical properties of the element within the exposed regions.
  • the optical properties changed though the polymerization of the MC include a change in the radius of curvature and/or a change in the refractive index.
  • the method for providing an aspheric lens begins with the formation of the first polymer matrix in the presence of the modifying composition.
  • the next step is the formation of a second polymer matrix comprising polymerized MC
  • This polymer network changes the optical properties of the element, namely the refractive index.
  • the MC is polymerized to form the second polymer matrix
  • a gradient or a difference in the chemical potential between the polymerized and unpolymerized regions is induced. This in turn causes the unpolymerized MC to diffuse within the element, which reestablishes a thermodynamic equilibrium within the optical element. If the optical element possesses sufficient elasticity, this migration of MC can cause swelling of the element in the area exposed to the stimulus.
  • This changes the shape of the element, causing changes in the optical properties (i.e., radius of curvature and/or refractive index). Whether the radius of curvature of the element and/or the refractive index of the element change depends upon ( 1 ) the nature of the optical element, (2) the MC incorporated into the element, (3) the duration that the element is exposed to a stimulus, and (4) the spatial intensity profile of the stimulus.
  • the optical elements are self-contained in that once fabricated, no material is either added or removed from the lens to obtain the desired optical properties.
  • Some embodiments of a Light Adjustable Lens can comprise a central region, centered on a central axis, having a position-dependent central optical power, and; a peripheral annulus, centered on an annulus axis and surrounding the central region, having a position-dependent peripheral optical power; wherein an average of the central optical power is at least 0.5 diopters different from an average of the peripheral optical power, and the central axis is laterally shifted relative to the annulus axis.
  • a Light Adjustable Lens comprises a light-adjusted region, centered on an adjustment axis and having a position-dependent optical power; wherein the adjustment axis is laterally shifted relative to a LAL axis of the LAL.
  • a method of adjusting a Light Adjustable Lens comprises the steps of: implanting a LAL into an eye; applying a first illumination to the LAL w'ith a first illumination pattern to induce a position-dependent peripheral optical power in at least a peripheral annulus, centered on an annulus axis; determining a central region and a corresponding central axis of the LAL; and applying a second illumination to the LAL with a second illumination pattern to induce a position-dependent central optical power in the central region of the LAL; wherein the central axis is laterally shifted relative to the annulus axis, and an average of the central optical power is at least 0.5 diopters different from than an average of the peripheral optical power.
  • a method of adjusting a Light Adjustable Lens comprises the steps of: implanting a LAL into an eye, the LAL having a pre-molded position- dependent peripheral optical power in at least a peripheral annulus, centered on an annulus axis; determining a central region and a corr esponding central axis of the LAL; and applying a central illumination to the LAL with a central illumination pattern to induce a position- dependent central optical power in the central region of the LAL; wherein the central axis is laterally shifted relative to the annulus axis, and an average of the central optical power is at least 0.5 diopters different from than an average of the peripheral optical power.
  • a method of adjusting a Light Adjustable Lens comprises the steps of: implanting a LAL, having a LAL axis, into an eye; and applying an illumination to the LAL with an illumination pattern to induce a position-dependent optical power in a light-adjusted region, centered on an adjustment axis: wherein the adjustment axis is laterally shifted relative to the LAL axis.
  • a method of adjusting a Light Adjustable Lens comprises the steps of: causing an LAL, implanted into an eye, to induce a first depth of focus of the ophthalmic optical system; determining a central region and a corresponding central axis of the LAL; and illuminating the LAL with an illumination pattern centered on the central axis to induce a second depth of focus of the ophthalmic optical system; wherein the central axis is laterally shifted relative to a LAL axis, and the second depth of focus is at least 0.5 diopters greater than the first depth of focus.
  • FIG. 1 shows a schematic representation of the depth of focus.
  • FIG.2 shows a collimated beam of light being refracted by a spherical lens.
  • FIG. 3 shows a schematic of the adaptive optics simulator used to determine the optimized values for 4 th order spherical aberration and defocus.
  • FIG.4 shows a schematic of positive power adjustment mechanism; wherein (a) is a schematic representation of selective irradiation of the central zone of the lens in which the polymerization of the MC creates a difference in the chemical potential between the irradiated and non-irradiated regions, (b) to reestablish equilibrium, excess MC diffuses into the irradiated region causing swelling, and (c) irradiation of the entire lens“locks" the remaining MC and the shape change.
  • FIG. 5 shows a plot of the aspheric function described in Equation 1.
  • FIG. 7 shows a plot of induced 4 th and 6 th order spherical aberration as a function of increasing b value.
  • the measurement aperture was 4 mm and none of these LALs received any type of prior adjustment
  • FIG. 8 shows a plot of induced 4 th and 6 th order spherical aberration as a function of increasing ⁇ value for LALs receiving a hyperopic, myopic, and no prior adjustment.
  • the measurement aperture for both the 4t hnd 6 th order spherical aberration was 4 mm.
  • FIG. 11 shows a comparison of the monocular and the binocular visual acuities for a series of patients that were corrected for distance emmetropia in one eye and received an aspheric treatment in their fellow eye. The amount of induced asphericity ranged from -0.04 mm to -0.10 mm, referenced to a 4 mm pupil.
  • FIG. 12 shows a comparison of the monocular and binocular visual acuities for a series of patients that were corrected for distance emmetropia in one eye and received an aspheric treatment in their fellow eye.
  • the amount of induced asphericity ranged from -0.1 1 mm to -0.23 mm, referenced to a 4 mm pupil.
  • FIGS. 13A-D illustrate a Light Adjustable Lens with position-dependent optical power and shifted axes, and stages of an illumination of the Light Adjustable Lens.
  • FIGS. 14A-B illustrate a Light Adjustable Lens with position-dependent optical power and shifted axes.
  • FIGS. 15A-C illustrate a position dependent optical power in a LAL.
  • FIG. 16 illustrates a Light Adjustable Lens with position-dependent optical power.
  • FIGS. 17A-B illustrate the visual acuity of presbyopic eyes, with implanted EDOF or CNA LALs.
  • FIG. 18 illustrates the visual acuity of presbyopic eyes, with implanted EDOF+CNA LALs.
  • FIG. 19 illustrates a Light Adjustable Lens with a peripheral optical power of differently-curved radial dependence compared to FIG. 1.
  • FIGS. 20A-C illustrate Light Adjustable Lenses with an average central optical power less titan an average peripheral optical power, with various radial dependence curvatures.
  • FIGS. 21A-B illustrate a LAL with a mid-range vision region.
  • FIG. 22 illustrates a LAL with a light-adjusted region, with a shifted adjustment axis.
  • FIG. 23 illustrates the position dependent optical power of a LAL
  • FIG. 24 illustrates a method of adjusting the LAL.
  • FIGS. 25A-B illustrate applying the first illumination and the second illumination to the LAL within the method.
  • FIG.26 illustrates applying a third illumination to the LAL.
  • FIGS. 27A-B illustrate applying the second and third illumination to the LAL.
  • FIG.28 illustrates a method of adjusting the LAL with a pre-molded LAL.
  • FIG.29 illustrates a generalized method of adjusting the LAL.
  • FIG.30 illustrates a method of adjusting the LAL.
  • a or “an” may mean one. or more.
  • the words “a” or “an” when used in conjunction with the word “comprising”, the words “a” or “an” may mean one or more than one.
  • “another” may mean at least a second or more.
  • the terms“comprise,”“have” and“include” are open-ended linking verbs. Any forms or tenses of one or more of these verbs, such as“comprises,” “comprising,”“has,”“having,”“includes” and“including,” are also open-ended. For example, any method that“comprises,”“has” or“includes” one or more steps is not limited to possessing only those one or more steps and also covers other unlisted steps.
  • the symbol "-" means a single bond, means a double bond, and means triple bond.
  • the symbol "----" represents an optional bond, which if present is either single or double.
  • the symbol represents a single bond or a double bond.
  • the structure includes the structures
  • geometry is undefined (e.g., either E or Z).
  • Any undefined valency on an atom of a structure shown in this application implicitly represents a hydrogen atom bonded to the atom.
  • a group“R” is depicted as a “floating group” on a ring system, for example, in the formula:
  • R may replace any hydrogen atom attached to any of the ring atoms, including a depicted, implied, or expressly defined hydrogen, so long as a stable structure is formed.
  • a group“R” is depicted as a“floating group” on a fused ring system, as for example in the formula:
  • R may replace any hydrogen attached to any of the ring atoms of either of the fused rings unless specified otherwise.
  • Replaceable hydrogens include depicted hydrogens (e.g. , the hydrogen attached to the nitrogen in the formula above), implied hydrogens a hydrogen of the formula above that is not shown but understood to be present), expressly defined hydrogens, and optional hydrogens whose presence depends on the identity of a ring atom (e.g., a hydrogen attached to group X, when X equals so long as a stable structure is formed.
  • R may reside on either the 5-membered or the 6-membered ring of the fused ring system.
  • the subscript letter“y” immediately following the group“R” enclosed in parentheses represents a numeric variable. Unless specified otherwise, this variable can be 0, 1 , 2, or any integer greater than 2, only limited by the maximum number of replaceable hydrogen atoms of the ring or ring system.
  • the following parenthetical subscripts further define the group/class as follows:“(Cn)” defines the exact number (n) of carbon atoms in the group/class.“(C£n)” defines the maximum number (n) of carbon atoms that can be in the group/class, with the minimum number as small as possible for the group in question, e.g.
  • saturated means the compound or group so modified has no carbon-carbon double and no carbon-carbon triple bonds, except as noted below.
  • the term does not preclude carbon-heteroatom multiple bonds, for example a carbon oxygen double bond or a carbon nitrogen double bond. Moreover, it does not preclude a carbon-carbon double bond that may occur as part of keto-enol tautomerism or imine/enamine tautomerism.
  • aliphatic when used without the“substituted” modifier signifies that the compound/group so modified is an acyclic or cyclic, but non-aromatic hydrocarbon compound or group.
  • the carbon atoms can be joined together in straight chains, branched chains, or non-aromatic rings (alicyclic).
  • Aliphatic compotmds/groups can be saturated, that is joined by single bonds (alkanes/alkyl), or unsaturated, with one or more double bonds (alkenes/alkenyl) or with one or more triple bonds (alkynes/alkynyl).
  • alkyl when used without the “substituted” modifier refers to a monovalent saturated aliphatic group with a carbon atom as the point of attachment, a linear or branched, cyclo, cyclic or acyclic structure, and no atoms other than carbon and hydrogen.
  • cycloalkyl is a subset of alkyl.
  • the groups CH 3 (Me), CH 2 CH 3 (Et), -CH 2 CH 2 CH 3 (n-Pr), -CH(CH 3 ) 2 (iso-Pr), -CH(CH 2 ) 2 (cyclopropyl), - CH 2 CH 2 CH 2 CH 3 (n- Bu), -CH(CH 3 )CH 2 CH 3 (sec-butyl), -CH 2 CH(CH 2 (io-butyl), -C(CH 3 )3 (tert-butyl), -CH 2 C(CH 3 )3 (neo-pentyl), cyclobutyl, cyclopentyl, cyclohexyl, and cyclohexylmethyl are non-limiting examples of alkyl groups.
  • alkanediyl when used without the “substituted” modifier refers to a divalent saturated aliphatic group, with one or two saturated carbon atom(s) as the point(s) of attachment, a linear or branched, cycle, cyclic or acyclic structure, no carbon-carbon double or triple bonds, and no atoms other than carbon and hydrogen.
  • the groups, -CH 2 (methylene), -CH 2 -CH 2 , CH 2 C(CH 3 ) 2 CH 2 .-CH 2 CH 2 CH 2 , and , are non-limiting examples of alkanediyl groups.
  • one or more hydrogen atom has been independently replaced by -OH, - F, -Cl, Br, I, NH 2 , NO 2 , -CO 2 H, CO 2 CH 3 , -CN, SH, OCH 3 , -OCH 2 CH 3 - C(O)CH 3 , N(CH 3 ) 2 , -C(O)NH 2 , -OC(O)CH 3 , or -S(O) 2 NH 2 .
  • the following groups are non- limiting examples of substituted alkyl groups: -CH 2 OH, -CH 2 CI, -CF 3 , -CH 2 CN, CH 2 CO OH, CH 2 C(O)OCH 3 , CH 2 C(O)NH 2 . CH 2 C O)CH 3 -CH 2 OCH 3 ,
  • haloalkyl is a subset of substituted alkyl, in which one or more hydrogen has been substituted with a halo group and no other atoms aside from carbon, hydrogen and halogen are present.
  • the group, CH 2 CI is a non-limiting examples of a haloalkyl.
  • An“alkane " refers to the compound H- R, wherein R is alkyl.
  • fluoroalkyl is a subset of substituted alkyl, in which one or more hydrogen has been substituted with a fluoro group and no other atoms aside from carbon, hydrogen and fluorine are present.
  • the groups, -CH 2 F, CF3, and -CH 2 CF 3 are non-limiting examples of fluoroalkyl groups.
  • An“alkane” refers to the compound H-R, wherein R is alkyl.
  • alkenyl when used without the“substituted” modifier refers to an monovalent unsaturated aliphatic group with a carbon atom as the point of attachment, a linear or branched, cycle, cyclic or acyclic structure, at least one nonaromatic carbon-carbon double bond, no carbon-carbon triple bonds, and no atoms other than carbon and hydrogen.
  • alkenediyl when used without the“substituted” modifier refers to a divalent unsaturated aliphatic group, with two carbon atoms as points of attachment, a linear or branched, cyclo, cyclic or acyclic structure, at least one nonaromatic carbon-carbon double bond, no carbon- carbon triple bonds, and no atoms other than carbon and hydrogen.
  • the groups, -CH CH-,
  • -CH C(CH 3 )CH 2
  • -CH CHCH 2 -
  • alkenediyl groups are non-limiting examples of alkenediyl groups.
  • one or more hydrogen atom has been independently replaced by --OH, -F, -Cl, - Br, I, --NH 2 , -NO 2 , -CO 2 H, -CO 2 CH 3 , -CN, -SH, -OCH 3 , OCH 2 CH 3 , C O)CH 3 -N(CH 3 ) 2 , C(O)NH 2 , OC(O)CH 3 , or -S(O) 2 NH 2 .
  • An“alkene” refers to the compound H-R, wherein R is alkenyl.
  • alkynyl when used without the“substituted” modifier refers to an monovalent unsaturated aliphatic group with a carbon atom as the point of attachment, a linear or branched, cyclo, cyclic or acyclic structure, at least one carbon-carbon triple bond, and no atoms other than carbon and hydrogen.
  • alkynyl does not preclude the presence of one or more non-aromatic carbon-carbon double bonds.
  • alkynyl groups are non-limiting examples of alkynyl groups.
  • alkynediyl when used without the“substituted” modifier refers to a divalent unsaturated aliphatic group, with two carbon atoms as points of attachment, a linear or branched, cyclo, cyclic or acyclic structure, at least one carbon-carbon triple bond, and no atoms other titan carbon and hydrogen.
  • one or more hydrogen atom has been independently replaced by -OH, -F, -Cl, - Br, l, - NH 2 , -NO 2 , -CO 2 H, -CO 2 CH 3 , -CN, -SH, -OCH 3 , OCH 2 CH 3 , -C(O)CH 3 , -N(CH 3 ) 2 , -C(O )NH 2 , OC(O)CH 3 , or -S(O) 2 NH 2 .
  • An“alkyne” refers to the compound H- R, wherein R is alkynyl.
  • aryl when used without the “substituted” modifier refers to a monovalent unsaturated aromatic group with an aromatic carbon atom as the point of attachment, said carbon atom forming part of a one or more six-membered aromatic ring structure, wherein the ring atoms are all carbon, and wherein the group consists of no atoms other than carbon and hydrogen. If more than one ring is present, the rings may be fused or unfused. As used herein, the term does not preclude the presence of one or more alkyl group (carbon number limitation permitting) attached to the first aromatic ring or any additional aromatic ring present.
  • Non-limiting examples of aryl groups include phenyl (Ph), methylphenyl, (dimethyl )phenyl, -C 6 H 4 CH 2 CH 3 (ethylphenyl), naphthyl, and the monovalent group derived from biphenyl.
  • the term“arenediyl” when used without the“substituted” modifier refers to a divalent aromatic group, with two aromatic carbon atoms as points of attachment, said carbon atoms forming part of one or more six-membered aromatic ring structure ⁇ ) wherein the ring atoms are all carbon, and wherein the monovalent group consists of no atoms other than carbon anti hydrogen.
  • the tenn does not preclude the presence of one or more alkyl group (carbon number limitation permitting) attached to the first aromatic ring or any additional aromatic ring present, if more than one ring is present, the rings may be fused or unfuscd.
  • alkyl group carbon number limitation permitting
  • arenediyl groups include:
  • aralkyl'' when used without the“substituted'' modifier refers to the monovalent group -alkanediyl-aryl, in which the terms alkanediyl and aryl are each used in a manner consistent with the definitions provided above.
  • Non-limiting examples of aralkyls are: phenylmethyl (benzyl, Bn) and 2-phenyl-ethyl.
  • one or more hydrogen atom from the alkanediyl and/or the aryl has been independently replaced by -OH, -F, -Cl, -Br, -I, -NH 2 , -NO2, -CO 2 H, -CO 2 CH 3 , -CN, -SH, -OCH 3 , -OCH 2 CH 3 , -C(O)CH 3 , -N(CH 3 ) 2 , -C(O)NH 2 , -OC(O)CH 3 , or -S(O) 2 NH 2 .
  • substituted aralkyls are: (3-chlorophenyl)-methyl, and 2-chloro-2- phenyl-eth-1-yl.
  • heteroaryl when used without the“substituted” modifier refers to a monovalent aromatic group with an aromatic carbon atom or nitrogen atom as the point of attachment, said carbon atom or nitrogen atom forming part of an aromatic ring structure wherein at least one of the ring atoms is nitrogen, oxygen or sulfur, and wherein the group consists of no atoms other than carbon, hydrogen, aromatic nitrogen, aromatic oxygen and aromatic sulfur.
  • the term does not preclude the presence of one or more alkyl group (carbon number limitation permitting) attached to the aromatic ring or any additional aromatic ring present.
  • heteroaryl groups include furanyl, imidazolyl, indolyl, indazolyl (Em), methylpyridyl, oxazolyl, pyridyl, pyrrolyl, pyrimidyl, pyrazinyl, quinolyl, quinazolyl, quinoxalinyl, thienyl, and triazinyl.
  • heteroarenediyl when used without the“substituted” modifier refers to an divalent aromatic group, with two aromatic carbon atoms, two aromatic nitrogen atoms, or one aromatic carbon atom and one aromatic nitrogen atom as the two points of attachment, said atoms forming part of one or more aromatic ring structure ⁇ ) wherein at least one of the ring atoms is nitrogen, oxygen or sulfur, and wherein the divalent group consists of no atoms other than carbon, hydrogen, aromatic nitrogen, aromatic oxygen and aromatic sulfur.
  • the term does not preclude the presence of one or more alkyl group (carbon number limitation permitting) attached to the first aromatic ring or any additional aromatic ring present. If more than one ring is present, the rings may be fused or unfused.
  • Non-limiting examples of heteroarenediyl groups include:
  • acyl when used without the“substituted” modifier refers io the group -C(O)R. in which R is a hydrogen, alkyl, aryl, aralkyl or heteroaryl, as those terms are defined above.
  • the groups CHO, C(O)CH 3 (acetyl, Ac), -C(O)CH 2 CH 3 , C(O)CH 2 CH 2 CH 3 , -C(O)CH(CH 3 ) 2 , -C(O)CH(CH 2 ) 2 , -C(O)C 6 H 5 , -C(O)C 6 H 4 CH 3 , -C(O)CH 2 C 6 H 5 ,
  • acyl groups are non-limiting examples of acyl groups.
  • A“thioacyl” is defined in an analogous manner, except that the oxygen atom of the group -C(O)R has been replaced with a sulfur atom, -C(S)R.
  • the“substituted” modifier one or more hydrogen atom has been independently replaced by OH, F, -Cl, Br, ⁇ 1, --NH 2 , -NO 2 , -CO 2 H, -CO 2 CH 3 , -CN, -SH, -OCH 2 CH 3 , ⁇ C( 0)CH 3 , -N(CH 3 ) 2 , -
  • alkoxy when used without the“substituted” modifier refers to the group - OR, in which R is an alkyl, as that term is defined above.
  • alkoxy groups include: -OCH 3 , -OCH 2 CH 3 , -OCH 2 CH 2 CH 3 , -OCH(CH 3 ) 2 , -OCH(CH 2 ) 2 , -O-cyclopentyl, and -O-cyclohexyl.
  • alkenyloxy when used without the“substituted” modifier, refers to groups, defined as -OR, in which R is alkenyl, alkynyl, aryl, aralkyl, heteroaryl, and acyl, respectively.
  • alkylthio when used without the“substituted” modifier refers to the group -SR, in which R is an alkyl, as that term is defined above.
  • the“substituted” modifier one or more hydrogen atom has been independently replaced by OH, F, Cl, Br, I, -NH 2 , NO 2 , CO 2 H, -CO 2 CH 3 , CN, -SH, -OCH 3 , -OCH 2 CH 3 , -C(O)CH 3 , -N(CH 3 ) 2 , -C(O)NH 2 , -OC(O)CH 3 , or -S(O) 2 NH 2 .
  • the term“alcohol” corresponds to an alkane, as defined above, wherein at least one of the hydrogen atoms has been replaced with a hydroxy group.
  • alkylamino when used without the“substituted” modifier refers to the group -NHR, in which R is an alkyl, as that term is defined above.
  • alkylamino groups include: -NHCH 3 and -NHCH 2 CH 3 .
  • dialkylamino when used without the“substituted” modifier refers to the group -NRR', in which R and R' can be the same or different alkyl groups, or R and R' can be taken together to represent an alkanediyl.
  • Non-limiting examples of dialkylamino groups include: -N(CH 3 ) 2 , -N(CH 3 )(CH 2 CH 3 ), and pyrrolidinyl.
  • dialkylamino groups include: -N(CH 3 ) 2 , -N(CH 3 )(CH 2 CH 3 ), and pyrrolidinyl.
  • alkoxyamino “alkenylamino”, “alkynylamino”, “aiylamino”, “aralkylamino”, “heteroaryl amino and “alkylsulfonylamino” when used without the “substituted” modifier, refers to groups, defined as - NHR, in which R is alkoxy, alkenyl, alkynyl, aryl, aralkyl, heteroaryl, and alkyisulfonyl, respectively.
  • a non-limiting example of an arylamino group is -NHC 6 H 5.
  • a non-limiting example of an amido group is -NHC(O)CH 3 .
  • alkylphosphate when used without the“substituted” modifier refers to the group -OP(O)(OH)(OR), in which R is an alkyl, as that term is defined above.
  • alkylphosphate groups include: P(O)(OH)(OMe) and -OP(O)(OH)(O t).
  • dialkylphosphate when used without the “substituted” modifier refers to the group -OP(O)(OR)( ⁇ ), in which R and R' can be the same or different alkyl groups, or R and R' can be taken together to represent an alkanediyl.
  • Non-limiting examples of dialkylphosphate groups include: -OP(O)(OMe) -OP(O) ( t)(OMe) and -OP(O)(OEt>2.
  • alkylsulfonyl and“alkylsulfinyl' when used without the“substituted” modifier refers to the groups -S(O) 2 R and -S(O)R , respectively, in which R is an alkyl, as that term is defined above.
  • alkenylsulfonyl “alkynylsulfonyl”, “arylsulfonyl”, “aralkylsulfonyl”, and“heteroarylsulfonyl” are defined in an analogous manner.
  • the term“patient” or“subject” refers to a living mammalian organism, such as a human, monkey, cow, sheep, goat, dog, cat, mouse, rat, guinea pig, or transgenic species thereof.
  • the patient or subject is a primate.
  • Non limiting examples of human subjects are adults, juveniles, infants and fetuses.
  • pharmaceutically acceptable refers to those compounds, materials, compositions, and/or dosage forms which are, within the scope of sound medical judgment, suitable for use in contact with the tissues, organs, and/or bodily fiuids of human beings and animals without excessive toxicity, irritation, allergic response, or other problems or complications commensurate with a reasonable benefit/risk ratio.
  • A“repeat unit” is the simplest structural entity of certain materials, for example, frameworks and/or polymers, whether organic, inorganic or metal -organic.
  • repeat units are linked together successively along the chain, like the beads of a necklace.
  • the repeat unit is -CH 2 CH 2 -.
  • the subscript“n” denotes the degree of polymerization, that is, the number of repeat units linked together.
  • the value for“n” is left undefined or where“n” is absent, it simply designates repetition of the formula within the brackets as well as the polymeric nature of the material.
  • the concept of a repeat unit applies equally to where the connectivity between the repeat units extends three dimensionally, such as in, modified polymers, thermosetting polymers, etc.
  • “Treatment” or“treating” includes (1) inhibiting a disease in a subject or patient experiencing or displaying the pathology or symptomatology of the disease arresting further development of the pathology and/or symptomatology), (2) ameliorating a disease in a subject or patient that is experiencing or displaying the pathology or symptomatology of the disease (e.g., reversing the pathology and/or symptomatology), and/or (3) effecting any measurable decrease in a disease in a subject or patient that is experiencing or displaying the pathology or symptomatology of the disease.
  • compositions of the present disclosure may be made using the methods described above and in Example 1 below. These methods can be further modified and optimized using the principles and techniques of organic chemistry and/or polymer chemistry as applied by a person skilled in the art Such principles and techniques are taught, for example, in March’s Advanced Organic Chemistry: Reactions, Mechanisms, and Structure (2007), and/or in R.J. Young & P.A. Lovell, Introduction to Polymers , (Chapman & Hall 1991 ), which are incorporated by reference herein.
  • the depth of focus (DOF) for an optical system is simply defined as the maximum movement away from the ideal image plane, which may be made without causing a serious deterioration of the image.
  • DOE depth of focus
  • AP represents a spherical wave converging to the image point B
  • l is the wavelength
  • n’ is the refractive index in the image space
  • U' is the slope of the retracted ray
  • dI is the DOF. Therefore, an optical system such as the human eye will have an inherent amount of depth of focus even for a perfectly imaging system.
  • FIG. 2 graphically depicts a collimated beam of light being refracted by a spherical biconvex lens. Notice that the rays closest to the optical axis come to a focus close to the paraxial focus position. As the ray height at the lens increases, the position of the ray's intersection with the optical axis moves farther and farther away from the paraxial focus. The distance from the paraxial focus to the axial intersection of the ray is called longitudinal spherical aberration.
  • the image of a point formed by a lens with spherical aberration is usually a bright dot surrounded by a halo of light.
  • the effect of spherical aberration on an extended image is to soften the contrast of the image and blur its details.
  • it should be possible to induce a specific spherical aberration that increases the depth of focus such that the softening of the focus and the image contrast is acceptable.
  • This instrument consists of a wavefront sensor (Shack-Hartmann wavefront sensor), a wavefront corrector (Liquid Crystal on Silicon (LCOS)), and an additional optical path to present letters, e.g., a tumbling E, to the subjects under test.
  • the visual acuity of several subjects was measured using a similar setup as that shown in FIG. 3.
  • the visual acuity of the subjects was measured through simulations that consisted of a number of different combinations of residual defocus and spherical aberration measurements for letter objects placed at distances from 30 cm to distance emmetropia.
  • the spherical IOL of the present invention is capable of post- fabrication alteration of optical properties.
  • the lens is self-contained and does not require the addition or removal of materials to change the optical properties. Instead, the optical properties of the lens are altered by exposing a portion or portions of the lens to an external stimulus which induces polymerization of a MC within the lens. The polymerization of the MC, in turn, causes the change in optical properties.
  • the optical element of the invention has dispersed within it a MC.
  • the MC is capable of diffusion within the lens; can be readily polymerized by exposure to a suitable external stimulus; and is compatible with the materials used to make the first polymer matrix of the lens.
  • the method for providing an aspheric lens begins with the formation of the first polymer matrix.
  • the second polymer matrix is formed by exposing the first polymer matrix, which further comprises the MC, to an external stimulus.
  • the first change is the formation of a second polymer matrix comprising polymerized MC.
  • the formation of the second polymer network can cause changes in the optical properties of the element, namely the refractive index.
  • the MC polymerizes a difference in the chemical potential between the polymerized and unpolymerized region is induced.
  • the optical element is typically made of a first polymer matrix.
  • a suitable first polymer matrix include: (1 ) polyacrylates such as polyalkyl acrylates and polyhydroxyalkyl acrylates; (2) polymethacrylates such as polymethyl methacrylate (“PMMA”), polyhydroxyethyl methacrylate (“PHEMA”), and polyhydroxypropyl methacrylate (“HPMA”); (3) polyvinyls such as polystyrene and polyvinylpyrrolidone (“PNVP”); (4) polysiloxanes such as polydimethylsiloxane; polyphosphazenes, and/or (5) copolymers thereof.
  • PMMA polymethyl methacrylate
  • PHEMA polyhydroxyethyl methacrylate
  • HPMA polyhydroxypropyl methacrylate
  • PMMA polymethyl methacrylate
  • PHEMA polyhydroxyethyl methacrylate
  • HPMA polyhydroxypropyl methacrylate
  • polyvinyls such as polys
  • the first polymer matrix generally possesses a relatively low glass transition temperature ( " Tg " ) such that the resulting IOL tends to exhibit fluid-like and/or elastomeric behavior, and is typically formed by cross-linking one or more polymeric starting materials wherein each polymeric starting material includes at least one cross-linkable group.
  • Tg glass transition temperature
  • the Tg should be less than 25°C. Tins allows the lens to be folded, facilitating implantation.
  • the crosslinking reaction of the polymeric starting material is accomplished via a hydrosiiylation reaction.
  • the general scheme for the hydrosilylation reaction is shown below.
  • a high molecular weight long vinyl-capped silicone polymer and multi-functional vinyl-capped silicone resin are crosslinked using multifunctional hydrosilane crosslinkers.
  • This crosslinking step forms the first polymer matrix in the presence of MC and photoinitiator.
  • the high molecular weight, long vinyl-capped silicone polymer has the following formula.
  • m represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1 ,500; 1 and 1 ,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • m represents an integer having an average value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6.500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1 ,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having a value between 1 and 10,000; 1 and 9.500; 1 and 9,000; 1 and 8,500; 1 and 8,000: 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4.500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having an average value between 1 and 10,000, 1 and 9.500; 1 and 9,000; 1 and 8,500; 1 and 8.000; 1 and 7,500; 1 and 7,000; t and 6,500; 1 and 6,000; I and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1.500; 1 and 1 ,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • multi-functional vinyl-capped silicone resin has the following formula.
  • x represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3.500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1 ,500; 1 and 1 ,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • x represents an integer having an average value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • y represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5.500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1 ,500; 1 and 1 ,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • y represents an integer having an average value between 1 and 10,000; 1 and 9,500; I and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • multi-functional hydrosilane crosslinker has the following formula.
  • n represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2.000; 1 and 1.500; 1 and 1.000; 1 aad 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having an average value between 1 and 10,000, 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8.000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1 ,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • the polymeric starting material includes terminal monomers (also referred to as endcaps) that are either the same or different from the one or more monomers that comprise the polymeric starting material but include at least one cross-linkable group.
  • the terminal monomers begin and end the polymeric starting material and include at least one cross-linkable group as part of its structure.
  • the mechanism for cross-linking the polymeric starting material preferably is different than the mechanism for the stimulus-induced polymerization of the components that comprise the refraction modulating composition.
  • the refraction modulating composition is polymerized by photoinduced polymerization, then it is preferred that the polymeric starting materials have cross-linkable groups that are polymerized by any mechanism other than photoinduced polymerization.
  • An especially preferred class of polymeric starting materials for the formation of the first polymer matrix is polysiloxanes (also known as“silicones”) endcapped with a terminal monomer which includes a cross-linkable group selected from the group consisting of vinyl, acetoxy, amino, alkoxy, halide, hydroxy, and mercapto. Because silicone lOLs tend to be flexible and foldable, generally smaller incisions may be used during the IOL implantation procedure.
  • An example of an especially preferred polymeric starting materials are vinyl endcapped dimethylsiloxane diphenylsiloxane copolymer, silicone resin, and silicone hydride crosslinker that are crosslinked via an addition polymerization by platinum catalyst to form the silicone matrix (see the above reaction scheme).
  • U.S. Patent No. 5,236,970; U.S. Patent No. 5,376,694; U.S. Patent No. 5,278,258; and U.S. Patent No. 5,444,106 are incorporated herein by reference in their entirety.
  • the MC that is used in fabricating IOLs is as described above except that it has the additional requirement of biocompatibility.
  • the MC is capable of stimulus-induced polymerization and may be a single component or multiple components so long as: (1) it is compatible with the formation of the first polymer matrix; (2) it remains capable of stimulus- induced polymerization after the formation of the first polymer matrix; and (3) it is freely diffusible within the first polymer matrix.
  • the same type of monomers that are used to form the first polymer matrix may be used as components of the refraction modulating composition.
  • the MC macromers generally tend to be smaller (i.e., have lower molecular weights) than the starting polymeric materials used to form the first polymer matrix.
  • the MC may include other components such as initiators and sensitizers that facilitate the formation of the second polymer network.
  • the stimulus-induced polymerization is photopolymerization, in other words, the one or more monomers or macromers that comprise the refraction modulating composition each preferably includes at least one group that is capable of photopolymerization.
  • the refraction modulating composition includes a photoinitiator (any compound used to generate free radicals) either alone or in the presence of a sensitizer.
  • a photoinitiator any compound used to generate free radicals
  • suitable photoinitiators include acetophenones (e.g., substituted haloacetophenones, and diethoxyacetophenone); 2,4-dichloromethyl-1,3,5-trazines; benzoin methyl ether; and o-benzoyl oximino ketone.
  • suitable sensitizers include p-(dialkyiamino)aryl aldehyde; N-alkylindolylidene; and bis[p-(dialkylamino)benzylidene] ketone.
  • an especially preferred class of MC monomers is poiysiloxanes endcapped with a terminal siloxane moiety that includes a photopolymerizable group.
  • a suitable photopolymerizable group include, but are not limited to acrylate, allyloxy, cinnamoyl, methacrylate, stibenyl, and vinyl. An illustrative representation of such a monomer is.
  • Y is a siloxane which may be a monomer, a homopolymer or a copolymer formed from any number of siloxane units, and X and X may be the same or different and are each independently a terminal siloxane moiety that includes a photopolymerizable group.
  • a suitable photopolymerizable group include, but are not limited to acrylate, allyloxy, cinnamoyl, methacrylate, stibenyl, and vinyl.
  • An illustrative example of Y includes:
  • R 1 , R 2 , R 3 and R 4 are independently each hydrogen, alkyl (substituted, primary, secondary, ternary, cycloalkyl), aryl, or heteroaryl.
  • R 1 , R 2 , R 3 , and R 4 are independently C 1 -C 10 alkyl or phenyl. Because MC monomers with a relatively high aryl content have been found to produce larger changes in the refractive index of the inventive lens, it is generally preferred that at least one of R 1 , R 2 , R3 and R 4 is an aryl, particularly phenyl.
  • R 1 , R 2 , and R 3 are the same and are methyl, ethyl or propyl with the proviso that R 4 is phenyl.
  • m represents an integer having a value between 1 and 10,000; 1 and 9,500; J and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1 ,500; 1 and 1 ,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • m represents an integer having an average value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having an average value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6.500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • R 5 and R 6 are independently each hydrogen, alkyl, aryl, or heteroaryl; and Z is a photopolymerizable group.
  • R 5 and R 6 are independently each C 1 -C 10 alkyl or phenyl and Z is a photopolymerizable group tiiat includes a moiety selected from the group consisting of acrylate, allyloxy, cinnamoyl, methacrylate, stibenyl, and vinyl
  • R 5 and R 6 are methyl, ethyl, or propyl and Z is a photopolymerizable group that includes an acrylate or methacrylate moiety.
  • a MC macromer has the following formula:
  • X and X 1 are the same as defined above, and wherein R 1 , R 2 , R 3 , and R 4 are the same as defined above.
  • m represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and
  • m represents an integer having an average value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and
  • n represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having an average value between 1 and 10,000, 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • a suitable modifying composition consists of a lower molecular weight polydimethyl-siloxane macromer containing polymerizable methacrylate functional end groups and a bezoin photoinitiator in some embodiments, a suitable modifying composition has the following formula.
  • the above structure is a polydimethyl siloxane end-capped with photopolymerizable methacrylate functional groups.
  • x represents an integer having a value between 1 and 10,000: I and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 ana 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and
  • x represents an integer having an average value between I and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and
  • n represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges in some examples, n represents an integer having an average value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2.500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • a suitable modifying composition has the following formula.
  • the above modifying composition has a structure comprising a polydimethyl siloxane end-capped with benzoin photoinitiator.
  • x represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000, 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and .500 or any range found within any of the aforementioned ranges.
  • x represents an integer having an average value between 1 and 10,000; 1 and 9,500; 1 and 9.000; 1 and
  • n represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and .3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having an average value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • MC monomers include dimethylsiloxane- diphenylsiloxane copolymer endcapped with a vinyl dimethylsilane group (see below);
  • m represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000, 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3.500: 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • m represents an integer having an average value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4.500: 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1 ,500; 1 aad 1 ,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having an average value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2.500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • MC monomers includes dimethylsiloxane- methylphenylsiloxane copolymer endcapped with a methacryloxypropyl dimethylsilane group (see below):
  • m represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000, 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • m represents an integer having an average value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having a value between I and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2.000; 1 and 1.500; 1 and 1.000; 1 and 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having an average value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • a preferred modifying composition is the dimethylsiloxane macromer endcapped with a metbacryloxypropyldimethylsilane group (see below).
  • x represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6.000; 1 and 5,500: 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1 ,500; 1 and 1 ,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • x represents an integer having an average value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000, 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having an average value between 1 and 10,000; 1 and 9.500: 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • a ring-opening reaction of one or more cyclic siloxanes in the presence of triflic acid has been found to be a particularly efficient method of making a class of MC monomers. Briefly, the method comprises contacting a cyclic siloxane with a compound of the formula.
  • the cyclic siloxane may be a cyclic siloxane monomer, homopolymer, or copolymer. Alternatively, more than one cyclic siloxane may be used.
  • a cyclic dimethylsiloxane tetrameter and a cyclic methyi- phenylsiloxane trimer are contacted with bis-methacryloxypropyltetramethyldisiloxane in the presence of triflic acid to form a dimelhyl-siloxane methyl-phenyisiioxane copolymer that is cndcapped with a methacryloxylpropyl-dimethylsilane group, an especially preferred MC monomer, such as the MC monomer shown below.
  • x represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000. 1 and 500 or any range found within any of the aforementioned ranges.
  • x represents an integer having an average value between 1 and 10,000; 1 and 9,500: 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1.500; 1 and 1 ,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000, 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500: 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having an average value between 1 and 10,000: 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000, 1 and 4.500: 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • acrylate-based MC can also be used in the practice of the invention.
  • the acrylate-based macromers of the invention have the general structure wherein X and X 1 may be the same or different and'or are each independently a terminal siloxane moiety that includes a photopolymerizable group.
  • a suitable photopolymerizable group include, but are not limited to acrylate, allyloxy, cinnamoyl, methacrylate, stibenyi, and vinyl
  • a and A 1 have the general structure:
  • R 1 is selected from the group comprising alkyls, halogenated alkyls, aryls and halogenated aryls and X and X 1 are groups containing photopolymerizable moieties and m and n are integers.
  • m represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000, 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500, 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • m represents an integer having an average value between 1 and 10.000: 1 and 9,500: 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500: 1 and 7,000: 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having a value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2.000; 1 and 1.500; 1 and 1.000; 1 and 500 or any range found within any of the aforementioned ranges.
  • n represents an integer having an average value between 1 and 10,000; 1 and 9,500; 1 and 9,000; 1 and 8,500; 1 and 8,000; 1 and 7,500; 1 and 7,000; 1 and 6,500; 1 and 6,000; 1 and 5,500; 1 and 5,000; 1 and 4,500; 1 and 4,000; 1 and 3,500; 1 and 3,000; 1 and 2,500; 1 and 2,000; 1 and 1,500; 1 and 1,000; 1 and 500 or any range found within any of the aforementioned ranges.
  • the acrylate based MC macromer has the formula:
  • R 2 is alkyl or halogenated alkyl
  • R 3 is alkyl, halogenated alkyl, aryl or halogenated aryls
  • R 4 is alkyl, halogenated alkyl, aryl or halogenated aryl; and, with the proviso that R 3 and R 4 are different.
  • the value of n is between 1 and 200; 1 and 190; 1 and 180; 1 and 170; 1 and 160; 1 and 150; 1 and 140; 1 and 130; 1 and 120; 1 and 1 10; 1 and 100; 1 and 90; 1 and 80; 1 and 70; 1 and 60; 1 and 50; 1 and 40, 1 and 30; 1 and 20; 1 and 10; or any range in betw een.
  • the value of n is between 1 and 200, this also contemplates a value of n between 17 and 24.
  • the value of m is between 1 and 200; 1 and 190; 1 and 180; 1 and 170; 1 and 160; 1 and 150; 1 and 140; 1 and 130; 1 and 120; 1 and 1 10; 1 and 100; 1 and 90; 1 and 80; 1 and 70; 1 and 60; 1 and 50; 1 and 40; 1 and 30; 1 and 20; 1 and 10; or any range in between.
  • the value of m is between 1 and 200, this also contemplates a value of m between 17 and 24.
  • the optical element After the optical element is formed, it is then positioned in the area where the optical properties are to be modified. For an intraocular lens, this means implantation into the eye using known procedures. Once the element is in place and is allowed to adjust to its environment, it is then possible to modify the optical properties of the element through exposure to an external stimulus.
  • the nature of the external stimulus can vary but it must be capable of reducing polymerization of the MC without adversely affecting the properties of the optical element.
  • Typical external stimuli that can be used in practice of the invention include heat and light, with light preferred. In the case of intraocular lenses, ultraviolet or infrared radiation is preferred with ultraviolet light most preferred.
  • the MC polymerization forms a second polymer matrix, interspersed within the first polymer matrix.
  • the polymerization is localized or when only a portion of the MC is polymerized, there is a difference in the chemical potential between the reacted and unreacted regions of the lens.
  • the MC then migrates within the element to reestablish the thermodynamic equilibrium within the optical element.
  • the formation of the second polymer matrix and the re-distribution of the MC can each affect the optical properties of the element.
  • the formation of the second polymer matrix can cause changes in the refractive index of the element.
  • the migration of the modifying compound can alter the overall shape of the element, further affecting the optical properties by changing the radii of curvatures of the optical element
  • optical element it is possible to expose the optical element to a spatially defined irradiance profile to create a lens with different optical properties.
  • An example of the type of profiles that can be used to induce asphericity in the lens are of the form
  • a and B are coefficients and p is a radial coordinate.
  • Another approach is to linearly combine weighted amounts of the profile (Asph) displayed in equation 1 with spatial irradiance profiles that are currently used to correct for spherical refractive errors and spherocylindrical refractive errors as well as with Power Neutral Profiles, i.e., profiles that neither add or subtract refractive power from the LAL.
  • This approach has the dual benefits of correcting the lower aberrations, e.g. sphere and cylinder, along with imparting the requisite amount of induced asphericity to provide increased depth of focus. This can be described mathematically as follows:
  • SCN(p) refers to either a spherical, spherocylindrical or power neutral spatial irradiance profile
  • Asph(p) is the same as in equation 1
  • b is a weighting factor that can range from 0 to 1.
  • the resulting radical species are free to react with the first polymer matrix.
  • the first polymer matrix was formed using a polymer having the following structure:
  • the reaction scheme for photopolymerization of photo-reactive MC in the presence of the first polymer lens matrix is the same for the adjustment and lock-in procedures.
  • the difference between the adjustment procedure and lock-in procedure is the spatial irra ance profiles applied to each procedure.
  • a series of light adjustable lenses containing a silicone-based MC were prepared using standard molding techniques known to those skilled in the art.
  • the lens had a first polymer matrix prepared from a silicone hydride crosslinked vinyl endcapped diphenylsiloxane dimethylsiloxane.
  • the first polymer matrix comprised about 70 weight % of the lens.
  • the lens also comprised about 30 weight % of a MC (methacrylate endcapped polydimethylsiloxane), 1 weight % (based on MC) of a photoinitiator (benzoin-tetrasiloxane- benzoin), and 0.04 weight % (based on MC) UV absorber.
  • the lenses had an initial nominal power of +20.0 diopters.
  • Table 1 Summary of treatment conditions and induced spherical aberration for those tenses that did not receive a prior adjustment.
  • the measurement aperture was 4 mm for all spherical aberration measurements.
  • the third feature to note is the small standard deviation in the average, induced 4 th order spherical aberration for a specific b value. This fact indicates that it is possible to adjust the amount of asphericity in the LAL by targeted, discrete values, which will allow true customization of patients' depth of focus. And finally, as written above, the targeted amount of total ocular 4 th order spherical aberration for optimizing visual acuity between 40 cm and distance emmetropia is 0.125 mm. Inspection of the data in Table 2 and FIG. 7 and assuming an average starting ocular spherical aberration at a 4 mm aperture of +0.10 mm, indicates that the profile with a beta value of 0.40 would be ideal for inducing the requisite amount of negative asphericity'.
  • the above example involved irradiating LALs that had not received a prior adjustment.
  • the LAL is a closed thermodynamic system, i.e. we can't add or remove particles, MC, front the lens.
  • MC particles
  • each subsequent refractive adjustment consumes MC leaving less for subsequent adjustments.
  • the polymerized MC forms an interpenetrating matrix with the host matrix polymer. This action has the effect of increasing the stiffness of the lens Because the refractive change, i.e.
  • FIG. 8 displays both the 4 th and 6 th order spherical aberration values for LALs that received either an initial hyperopic or myopic adjustment followed by an aspheric treatment with beta values ranging between 0.30 and 0.57.
  • the LALs that received the aspheric treatment as a primary' adjustment are also plotted on the same graph.
  • the first which was discussed above, is due to the simple fact that the LALs that received no prior adjustment obviously have more starting MC and the LAL matrix is not as stiff as compared to the other two sets of LALs and thus, for the same given aspheric dose, should show more 4 th order asphericity induction.
  • FIG. 9 and Table 2 summarize the monocular visual acuity data for a series of 32 eyes adjusted with aspheric profiles possessing a beta value between 0.40 and 0.57.
  • AH of the LALs received some type of primary adjustment before the application of the aspheric profile.
  • the total measured 4 th order spherical aberration over a 4 mm pupil in the 32 eyes ranged from 0.04 mm to 0.23 mm.
  • theoretical considerations indicate that the ideal amount of final 4 th order spherical aberration to provide optimal visual acuity between 40 cm and distance emmetropia is -0.125 mm.
  • FIG. 10 segregates the 32 eyes into two groups: High Spherical Aberration (- 0.10 mm to -0.23 mm) and Low Spherical Aberration (-0.04 mm to -0.10 mm).
  • the binocular visual acuity data indicates that combining the two eyes provide outstanding visual acuities from 40 cm to distance emmetropia. In fact, 100% of the patients possessed a visual acuity of 20/25 or better from 40 cm to distance emmetropia. Table 6.
  • Binocular visual acuity results for those eyes with low amounts of final 4th order spherical aberration, -0.04 to -0.10 mm in their non-dominant eye and with their other eye adjusted for distance emmetropia.
  • Binocular visual acuity (VA) results for those eyes with high amounts of final 4th order spherical aberration, -0.1 1 to -0.23 mm in their non-dominant eye and with their other eye adjusted for distance emmetropia.
  • the refraction in the dominant eye ranged from +0.25 D to -0.25 D (n-4).
  • General examples disclosed herein include an optical element composed of matrix polymer and a modulating composition (MC) that can be polymerized by an external stimulus (e.g. heat, light, etc) to control the amount of induced asphericity.
  • MC modulating composition
  • the lens may include an optical element that is a lens.
  • the optical element is an intraocular lens (lOL).
  • the amount of induced asphericity is controlled by the application of a specific spatial irradiance profile in some examples, the amount of induced asphericity is induced monocuiarly to induce extended depth of focus.
  • the amount of induced asphericity is tailored to provide intermediate vision (60-80 cm) or near vision (30-40 cm). In specific embodiments, the amount of induced asphericity can be customized for specific individual values.
  • the amount of induced asphericity is induced binocularly to induce extended depth of focus.
  • one eye is tailored for intermediate (60-80 cm) vision by the induction of a particular value of asphericity and the other eye is corrected for distance emmetropia.
  • one eye is tailored for near vision (30-40 cm) by the induction of a particular value of asphericity and the other eye is corrected for distance emmetropia.
  • both eyes are tailored for intermediate (60- 80 cm) vision by the induction of particular value of asphericity.
  • both eyes are tailored for near (30-40 cm) vision by the induction of particular value of asphericity.
  • one eye is tailored for intermediate (60-80 cm) vision by the induction of negative asphericity and the other eye is tailored for intermediate vision (60- 80 cm) vision by the induction of positive asphericity.
  • one eye is tailored for near vision (30-40 cm) vision by the induction of negative asphericity and the other eye is tailored for near vision (30-40 cm) vision by the induction of positive asphericity.
  • the amount of induced asphericity of the lens is tailored to compensate for the spherical aberration of the cornea. In other examples, the amount of induced asphericity of both lenses are tailored to compensate for the spherical aberration of their respective corneas. In alternate examples, one lens is adjusted to remove the spherical aberration of the entire eye and the other lens is adjusted to induce asphercity for intermediate vision (60-80 cm). In some examples, one lens is adjusted to remove the spherical aberration of the entire eye and the other lens is adjusted to induce asphercity for near vision (30-40 cm).
  • FIGS. 13A-B illustrate that, in order to address the above described needs, embodiments of a Light Adjustable Lens (LAL) 100 can comprise a central region 1 10, centered on a central axis 1 12, and a peripheral annulus 120, centered on an annulus axis 122 and surrounding the central region 1 10, wherein the central axis 1 12 is laterally shifted relative to the annulus axis 122 and the LAL axis 102.
  • LAL Light Adjustable Lens
  • FIGS. 13C-D show steps of a light adjustment procedure that can be used to form the LAL 100 of FIGS. 13A-B.
  • the annulus axis 122 can be centered on the LAL axis 102, or on the center of the dilated iris 5.
  • the dilated/non-diiated status of the iris 5 is indicated in the Figures.
  • a first illumination 222 can be applied to form the peripheral annulus 120, with a peripheral optical power 124, in the LAL 100, centered on the annulus axis 122.
  • the peripheral annulus 120 can be pre-molded into the LAL 100, instead of being formed after implantation.
  • FIG. 13D shows that next, the central axis 1 12 can be centered on a visual axis 132 of the eye, e.g., after the iris 5 returned to its non-dilated state. Subsequently, a second illumination 242 can be applied to form the central region 1 10, with a central optical power 114, centered on this central axis 1 12, in order to optimize the optical performance of the LAL 100. In this procedure, the central axis 1 12 often ends up shifted relative to the annulus axis 122 and the LAL axis 102 for several reasons, including the following.
  • the doctor may have not selected the optimal, most centered position for the LAL 100.
  • surgeon may have ended up implanting the LAL 100 in a position shifted from the presurgical planned position.
  • the LAL 100 may have shifted, or tilted away from its planned position, as shown in FIGS. 13C-D.
  • the first illumination 222 is often applied with the iris 5 being dilated, to create the peripheral annulus 120 large enough to provide the desired optical performance even when the iris 5 is in its most dilated state.
  • the considerably smaller central region 1 10 is preferably formed with a non-dilated iris 5, in order to center it on the visual axis 132 with high precision. This is so because the optical performance of the small central region 1 10 deteriorates noticeably if it is not aligned with the visual axis 132 well.
  • the central axis 1 12 is often shifted relative to the annulus axis 122.
  • the shift of the central axis 1 12 relative to the annulus axis 122 will be sometimes abbreviated as axis shift 1 1 1.
  • the axis shift 1 1 1 can be captured in various ways. In absolute terms, the axis shift 1 1 1 can exceed 0.1 mm. In some embodiments, the axis shift 1 1 1 can exceed 0.2 mm.
  • the axis shift 1 11 can exceed 0.5 mm. In relative terms, the axis shift 1 1 1 can exceed 5% of the diameter of the central region 1 10. In some embodiments, the axis shift 1 1 1 can exceed 10% of the diameter of the central region 1 10. In yet others, it can exceed 20% of the diameter of the central region 1 10. Finally, in manufacturing terms, the axis shift 1 1 1 can exceed a manufacturing radius- tolerance of the IAL 100 by 20%. In other embodiments, the axis shift 111 can exceed the manufacturing radius-tolerance of the LAL 100 by 50%. This definition captures that the axis shift 1 1 1 is not an accidental, or tolerance-induced unintended shift of a pre-molded multifocal IOL, but an intended shift, exceeding the manufacturing tolerance.
  • FIG. 13L illustrates the optical power of the LAL 100 as a function of a radius r.
  • the radius can be measured from a LAL axis 102.
  • the central region 1 10 can have a position- dependent central optical power 114.
  • the peripheral annulus 120 can have a position-dependent peripheral optical power 124.
  • an average of the central optical power 114 can be at least 0.5 diopter different from an average of the peripheral optical power 124.
  • the average of the central optical power 114 can be at least 1.0 diopter different from the average of the peripheral optical power 124. Since the central axis 1 12 is shifted relative to the annulus axis 122, which itself may be shifted relative to the LAL axis 102, the central region 1 10 may be off a center of the IAL 100, as shown.
  • the embodiments of the LAL 100 blend various aspects of the EDOF and the CNA IOLS, since the LAL 100 has both a radially varying optical power, thus giving rise to an EDOF, as well as a central region 1 10, sometimes referred to as CNA region 1 10, and is thus shares some of the attributes of a multifocal lens. For this reason, embodiments of the LAL 100 will be interchangeably also referenced as a blended LAL 100.
  • FIG. 13B illustrates the same regions of the LAL 100, from a perspective along the LAL, axis 102 of the LAL 100.
  • the LAL axis 102, the central axis 1 12, and the annulus axis 122 can alt be different.
  • the LAL axis 102 and the annulus axis 122 can at least approximately coincide, and the central axis 1 12 can be shifted relative to both the LAL axis 102 and the annulus axis 122, as shown.
  • the position dependent optical power is typically induced by illuminating the LAL 100 by applying a suitable illumination pattern.
  • the edge of the illumination pattern, a pattern edge 126 is also shown in FIGS. 13A-B, as a perimeter.
  • Such blended LALs 100 can provide improvements for the above described medical problems at least as follows.
  • the central axis 112, and thus the central, or CNA region 110 can be centered with the visual axis 132 of the eye with the iris 5 being in a non-dilated state. It is recalled that the visual axis 132 of the eye with the iris 5 being in its non-dilated state often differs from either the geometrical LAL axis 102 of the LAL 100, and from the visual axis of the eye with the iris 5 in its dilated state.
  • a method that determines the eye visual axis 132 only after the LAL 100 has shifted and settled in the eye, and after the iris 5 returned to its approximately non-dilated state, and only then applies the second illumination 242 centered on the central axis 112 that is aligned with the eye visual axis 132, is an efficient method to center the CNA region 110 properly.
  • the central axis 112 often ends up laterally shifted relative to the annulus axis 122, as was described in relation to FIGS. 13A-B.
  • the described embodiments of the blended LAL 100 are capable of overcoming the above-mentioned de- centering challenge of pre-tbrmed multifocal/CNA lOLs, and avoid the shift-induced aberrations, such as coma.
  • the peripheral annulus 120 can be formed with a considerably smaller radial variation of the peripheral optical power 124, which thus extends the depth of focus only to a considerably smaller degree. Therefore, the blurriness and aberrations, caused by the peripheral annulus/EDOF region 120 of the blended LAL 100 is substantially less than in an EDOF-only IOL/LAL.
  • the radial variation of the peripheral optical power 124 can be selected to induce a spherical aberration that compensates a spherical aberration caused by the cornea of the eye.
  • This compensation can be partial, or an essentially complete compensation.
  • the implantation of such spherical aberration-compensating blended LALs 100 can advantageously minimize the imaging aberrations of the entire ophthalmic system of the eye.
  • the here-described embodiments of the blended LAL 100 retain much of the medical benefits of the separate EDOF and the CNA designs, while they mitigate and minimize the undesirable side effects of these designs. These benefits also characteristically distinguish the blended LAL. 100 embodiments from the mentioned pre-formed multifocal CNA IOLs, corneal inlays, and CNA contact lens.
  • the first illumination 222 can have any of the illumination patterns described in FIGS. 1-12, as applicable, used to increase the depth of focus of the implanted LAL.
  • the lens materials and lens optical properties of the LAL 100 can have any material and property, described in relation to FIGS. 1-12. as appropriate.
  • the average of the central optical power 1 14 is at least 0.5 diopter higher than the average of the peripheral optical power 124. In some embodiments, the central optical power 1 14 is at least 1.0 diopter higher than the average of the peripheral optical power 124. As such, the central region 1 10 is adapted to provide improved near vision, and the peripheral annulus 120 provides improved distance vision. In the embodiments of FIGS. 20A-C, the average of the central optical power 1 14 is at least 0.5 diopter lower than the average of the peripheral optical power 124. In some embodiments, the average of the central optical pow er 1 14 is at least 1.0 diopter lower than the average of the peripheral optical power 124.
  • the central region 1 10 is adapted to provide improved distance vision, and the peripheral annulus 120 provides improved near vision.
  • the central region 110 can be called a Central Near Add (CNA) region 110 for the embodiments of FIGS, 13-19, while for the embodiments of FIGS. 20A-C, the central region 1 10 can be referred to as Central Distance Add (CDA), or Peripheral Near Add (PNA) region. These latter phrases are less widely used.
  • CNA Central Near Add
  • PNA Peripheral Near Add
  • the term“average” can be defined in various suitable manners.
  • the average can refer to an area integral of the optical power.
  • only a portion, or fraction, of the total area of the central region 1 10 and the peripheral annulus 120 can be used to compute the average as an area integral.
  • Such fractional definitions of the average can be useful to de-emphasize, or disregard non- representative deviations close to the pattern edge 126, or close to the region separating the central region 1 10 from the peripheral annulus 120.
  • the fractional area can be at least 25% of the total area of either the central region 1 10, or the peripheral annulus 120. In other embodiments, this can fractional area can be 50%, 75%, or 90%.
  • the average can be defined along a representative circle, or over a band, or with a weighting function, or as a moment of a certain order of the optical power.
  • FIGS. 14A-B illustrate the position of these regions relative to the physical structure of the LAL 100.
  • the front and rear surfaces of the LAL 100 Prior to forming the peripheral armulus 120 and the central region 1 10 in the LAL 100 by illuminations 222/242, the front and rear surfaces of the LAL 100 typically have a single, approximately constant curvature, and, accordingly, have an optical power that is either independent of the position, or depends on it very weakly, only due to the finite thickness of the LAL 100, for example.
  • the central axis 1 12 is often shifted relative to the LAL axis 102, in order to compensate for the postsurgical shift and tilt of the LAL 100 that misaligned the LAL axis 102 with the visual axis 132 of the eye with the iris 5 in its non-dilated state.
  • the annulus axis 122 also ends up being shifted relative to the LAL axis 102.
  • the central optical power 114 and the peripheral optical power 124 meet at a sharp boundary. In other examples, a smoother transition optical power 134 of a transition 130 can be between them.
  • FIG. 14B shows the LAL 100 of FIG. 14A, from the perspective of the LAL axis 102, the relative positions of the central region 1 10 and the peripheral annulus 120, and the central axis 1 12 being shifted relative to the annulus axis 122 by the axis shift 1 1 1.
  • the physical structure of the LALs 100 includes a lens edge 146, continuing in a LAL rim 148 to a LAL rim edge 149.
  • the haptics 105 protrude well beyond the LAL rim edge 149, to wedge and to stabilize the LAL 100 into the capsular bag emptied by the cataract surgery.
  • the pattern edge 126 of the first illumination 222 typically does not reach all the way to the lens edge 146, it stops just before it. In some embodiments, the pattern edge 126 may coincide with the lens edge 146, or even extend to the LAL rim 148, that is initially flat and thus has no optical power.
  • the LAL 100 typically also includes a UV (i.e. ultra-violet illumination) absorbing layer 127.
  • the first and second illuminations 222/242 are applied from the side of the LAL 100 opposite of this UV absorbing layer 127. A role of this UV absorbing layer 127 is to reduce the transmitted portion of the illuminations to completely safe levels.
  • FIGS. 13A-B and FIGS. 14A-B further illustrate that the LAL 100 can also include a transition 130, between the central region 1 10 and the peripheral annulus 120,
  • the transition 130 can have a transition optical power 134 that changes from the central optical power 114 to the peripheral optical power 124.
  • the overall difference between the central optical power 1 14 and the peripheral optical power 124 will sometimes be referred to as an optical power change
  • the double wavy lines indicate that the LAL 100 has an additional,“base” optical power in the 5 - 35 diopters range, typically within a few diopters of 20 diopters, whereas the position dependent peripheral optical power 124 may vary 0.5-2 diopters in the peripheral annulus 120; the transition optical power 134 may vary 0.5-2 diopters in the transition 130, and the central optical power 114 may vary 0.1-1 diopters in the central region 1 10, as an illustration. Broader ranges can be employed in some embodiments.
  • FIGS. 15A-C illustrate the results of measurements of the optical power as a function of the radial distance of the blended LAL 100 in the main stages of the formation process, as indicated in FIGS. 13C-D.
  • Such optical power measurements can be performed by several known methods and apparatuses, such as wavefront measurement systems, and aberrometers, especially Shack-Hartmann wavefront sensors, among others.
  • FIG. ISA shows the radially varying optical power prior to the first illumination 222 in a LAL 100 that has a pre-molded radially vary ing optical power, causing a spherical aberration.
  • FIG. 15B illustrates the result of the same optical power measurement after the first illumination 222 has been applied, centered on an annulus axis 122, which in this case was chosen to coincide with the LAL axis 102.
  • the OP got enhanced to 20.8 D, while at the center to 22.8 D.
  • FIG. ISC shows the radially varying optical power of the blended LAL 100 after the second illumination 242 has been also applied to induce a CNA in a central region 1 10.
  • the second illumination 242 was centered on a central axis 1 12 that was shifted from the annulus axis 122, as shown.
  • the overall LAL optical power is a function of the radius in these blended LALs 100, and thus so is the overall focal distance. Accordingly, these blended LALs 100 can be characterized as“polyfocal lOLs", or“polyfocal. LALs 100" as well
  • FIG. 15C the central, or CNA, region 1 10 was formed over a diameter of 1.5 mm. Within this central region 1 10 the central optical power 1 14 is often intended to be quite smooth.
  • FIGS. 15A-C illustrate a precision of the above numerical values and ranges, caused by natural measurement uncertainties and variations. The variations of the optical power measurements are high for small radii and decrease with increasing radius because the accuracy of the measurement of a region’s optical power is set by the area of the region, and thus the variations are inversely proportional to this same area. The quadratically smaller area of the central region 1 10 compared to the peripheral annulus 120 explains that the fluctuations of the measured central optical power 114 are visibly greater than that of the peripheral optical power 124.
  • FIG. 15C illustrates that in some embodiments , measurements of the central optical power 1 14 will exhibit an optical power variation 1 15, of 0.2 D. In other cases, the optical pow'er variations 1 15 in the central optical power 1 14 can be up to 0.4 D.
  • FIG. 16 illustrates that in some embodiments the central optical power 1 14 can have an optical power variation 115 of a tew tenth of diopters that arises not from measurement-related fluctuations, but from the smooth curving central optical power 1 14.
  • the central region 110 can directly meet the peripheral annulus 120 at a well-defined boundary, making the transition 130 a sharp boundary; and the central region 1 10 and the peripheral annulus 120 can meet at this sharp boundary.
  • FIG. 13A, FIG. 15C and other Figures show that in some other embodiments, the transition 130 can be a smoother transition annular region between the central region 1 10 and the peripheral annulus 120.
  • the smoothness of the transition 130 can be captured via ratios of relevant radii.
  • FIG. 15C illustrates such relevant radii: a radial width of the transition 130, ART 154, and an outer radius RT 152 of the transition 130.
  • the ratio DRT/RT can be less than 0.3.
  • ⁇ RT/RT can be less than 0.5, in yet others, less than 0.7.
  • a typical value for a radius RC 156 of the central region 1 10 can be in the range of 0.5 mm to 1.0 mm in some embodiments.
  • the LAL, 100 can be characterized in isolation, on an optical bench, where the LAL 100 is typically immersed into a saline solution to mimic its optical performance in the aqueous of the eye.
  • Such measurements can be set up at least in the following ways, (la) Starting with a LAL 100 that has not been light adjusted yet; then performing a light adjustment illumination protocol as defined by the LAL manufacturer; and then measuring the optical characteristics of the light-adjusted LAL 100 on the optical bench, (lb) Implanting the LAL 100 into a patient’s eye; then performing the light adjustment illumination protocol in the eye; then explanting the light-adjusted LAL 100 from the patient’s eye; and finally, measuring the optical characteristics of the explanted LAL 100 again on the optical bench.
  • the LAL 100 can be characterized“in situ", as part of the overall ophthalmic optical system that includes the LAL 100 and the cornea that has its own optical power and own spherical aberration, the two lenses separated by a space filled by the aqueous of the anterior chamber of the eye. Defining such an“in situ” protocol can be particularly useful if the optical power of an implanted LAL needs to be determined without explanting the LAL from the patient’s eye.
  • two related optical measurement approaches can be described.
  • d is the separation between the cornea 15 and the LAL 100.
  • Pc about 40-45 D and d about 7 mm
  • a 1 D change in the optical power P LAL in the LAL plane approximately translates to an about 0.7 D change in the overall optical power Po in the corneal plane, defined approximately as a plane at the vertex of the cornea 15.
  • Eq. (4) below shows that the optical (lower of the entire eye ophthal mic optical system can be also calculated with an analysis that includes more parameters and details, such as additionally capturing beam propagation from the cornea to the separately located spectacle plane.
  • Eq. (4) below shows the change in power of the implanted LAL necessary to achieve a Specific refractive correction of the eye at the spectacle plane, Rx, determined as the refractive correction heeded after the LAL 100 has been implanted into the eye.
  • Typical Values in Eq. (4) include a comeal power , and
  • a diameter of a beam propagating from the LAL out to the cornea increases by a factor of 1 /0.85.
  • Titus e.g., a comeal beam diameter of 6 mm gets focused down to a 5.1 mm LAL-plane beam diameter, and a comeal beam diameter of 4.7 mm gets focused down to a 4.0 mm LAL-plane beam diameter. It is customary to characterize the SA values of contact lenses, positioned on the cornea, at a d :::: 6 mm diameter. It is also customary to characterize 101.
  • a LAL/IOL plane SA value measured at 4 mm diameter is to be converted to the diameter of 5.1 mm that corresponds to the 6 mm corneal diameter by the down-focusing factor of 0.85.
  • the central optical power 1 14 can have only a limited spatial variation, and a corresponding approximately flat position-dependence, since limiting spatial variations limits the aberration of the imaging, and thus improves the visual acuity.
  • the central region 110 can have an optical power variation less than 0.2 diopters over 50% of the central region 1 10, resulting in high visual acuity.
  • the central optical power 1 14 can be a function of a radius from the central axis 112, having an optical power variation 1 15 greater than 0.2 diopters over 50% of the central region 1 10. These embodiments may be emphasizing the presbyopia mitigation benefit.
  • the peripheral optical power 124 can have an approximately flat position-dependence, having an optical power variation less than 0.2 diopters over 50% of the peripheral annulus.
  • the peripheral optical power 124 can be a function of a radius from the annulus axis 122, having an optical power variation greater than 0.2 diopters over 50% of the peripheral annulus.
  • FIGS. 17L-B and 18 illustrate how the LAL 100 with the above characteristics mitigates the presbyopic medical needs, described earlier.
  • VA Visual Acuity
  • EDRS Early Treatment Diabetic Retinopathy Study
  • logMAR logMAR, where“MAR” abbreviates“Minimal Angle Resolved”, and“log” references that the logarithm of this angle is taken for this measure.
  • FIGS. 17A-B and 18 demonstrate the problem of presbyopia and the improved visual acuity delivered by the blended LALs 100.
  • a young eye has an easily deformable crystalline lens, and therefore can accommodate to a wide range of viewing distances. This is seen in FIG.
  • Presbyopia is, in fact, Greek for“old eyes”, or“old sight”.
  • the DOF of the shown presbyopic eye decreased to DOF(presbyopic) ⁇ +0.5D-(-0.5D) ⁇ 1 D, approximately.
  • FIG. 17B illustrates the two presbyopia solutions, discussed earlier.
  • lOLs with an Extended Depth of Focus, or EDOF lOLs are formed with a radially varying optical power that extends the focal point into an elongated focal region.
  • the adaptiveness of the human vision enables the patient’s brain to extract images created with this elongated focal region, to see targets in a wider range. This adaptiveness smoothly broadens the logMAR curve, extending the DOF to DOF(EDOF) » +0.5D-(-1.5D) * 2D.
  • CNA IOLs extend the DOF better than EDOF IOLs, DOF(CNA) > DOF(EDOF). However, they do so at the expense of a noticeable reduction of the midrange visual acuity, as shown by the pronounced IogMAR minimum around -0.5D.
  • FIG. 18 illustrates the IogMAR curve of the blended tALs 100, which blend the EDOF and the ON A techniques.
  • the blended EDOF+CNA LALs 100 also largely eliminate the midrange IogMAR minimum of the CNA lOLs.
  • the blended EDQF+CNA LALs 100 deliver the longer DOFs of the CNA IOLs, as well as the no-midrange- minimum smoothness of the EDOF lOLs.
  • blended LALs 100 deliver the positives of the two existing presbyopia IOLs, while eliminating their drawbacks.
  • FIGS. 13-18 illustrated blended LALs 100.
  • the central optical power 1 14 was higher than the peripheral optical power 124, at least in an average sense.
  • the optical power was a decreasing function of the radius (2) in the central region 1 10, and (3) in the peripheral annulus 120, shown by the downward curvatures of the optical power curves in both of these regions.
  • These three design factors (l)-(3) can be combined in 2 j::: 8 different ways, defining 8 possible embodiments of the blended LALs 100. All 8 combinations can offer advantages for visual challenges.
  • FIGS. 19 and 20A-C illustrate four of these eight possible combinations of the design factors.
  • the central optical power 1 14 is still greater than the peripheral optical power 124, and the central optical power 1 14 still has a downward curvature.
  • the peripheral optical power 124 has an upward curvature.
  • Such optical designs also have an extended depth of focus, but the geometric relation between light rays from larger radii and smaller radii is reversed.
  • the peripheral annulus 120 does not extend the depth of focus beyond the DOF extension induced by the central region 1 10.
  • an advantage of the design of FIG. 19 is that it“fills in” the midrange IogMAR minimum even more efficiently than previously described designs, thereby delivering an improved overall visual acuity.
  • FIGS. 20A-C show three embodiments, where the central optical power 114 is less than the peripheral optical power 124, at least in the above defined average sense.
  • the central region 1 10 is providing good distance vision and the peripheral annulus 120 provides good near vision.
  • these embodiments and designs can be called Central Distance Add fCDA) LALs, or Peripheral Near Add (PMD) LALs. These are less frequently used terms, as mentioned before.
  • the central optical power 114 and the peripheral optical power 124 are both decreasing functions of the radius.
  • the central optical power 1 14 increases with the radius, while the peripheral optical power 124 decreases with the radius.
  • the central optical power 1 14 and the peripheral optical power 124 are both increasing functions of the radius.
  • the central optical power 114 can be a quadratic function of the radius from the central axis 1 12 over the central region 1 10, optionally having a small correction term, or can have a quadratic component.
  • the peripheral optical power 124 can be a quadratic function of the radius from the annulus axis i 22 over the annular region 120, optionally with a small correction term, or can have a quadratic component.
  • the radius dependent optical power P(r) is related to the wavefront W(r) as:
  • the above-described quadratic functions or components of the optical power P(r) correspond to a wavefront aberration proportional to the fourth power of the radius.
  • the simplest fourth order aberration is the angle independent spherical aberration, or SA, its coefficient often denoted by Z(4,0), or Z12 in Zemike notation.
  • SA angle independent spherical aberration
  • embodiments of the blended LAL 100, where the position dependence of the optical power P(r) has a quadratic function or component can be also characterized by a corresponding spherical aberration.
  • ranges of the spherical aberrations SA of some blended LALs 100 will be characterized.
  • the described SA values can be induced by the peripheral optical power 124 alone, or by a combination of the central optical power 1 14, the peripheral optical power 124, and the transition optical power 134 of the blended LAL 100.
  • An example of the former case is a pre molded LAL 100, where a spherical aberration has been molded into the LAL 100, including into its peripheral annulus 120, measured before the central region 1 10 has been formed.
  • An example of the latter case is a LAL 100, where the central region 1 10 has been already formed, typically after implantation.
  • the spherical aberration with one of the above definitions can be in the -0.05 mm to -1 mm range at a diameter of 4 mm in a plane of the LAL. In some embodiments, the spherical aberration can be in the -0.05 mm to -0.35 mm range at a diameter of 4 mm in a plane of the LAL. In yet other embodiments, the spherical aberration can be in the -0.10 mm to -0.25 mm range at a diameter of 4 mm in a plane of the LAL.
  • these LAL-plane SA values translate to SA values measured at a 6 mm diameter at the comeal plane approximately by a scale factor of about 2.6, or in a range around 2.6, such as the range of 2.4-2.8, or 2.2-3.0. Since the translation factor can vary over these narrow, but finite ranges, corneal plane S A values will be expressly described next. This translation of the SA values can be particularly useful if the SA of an implanted LAL 100 needs to be determined without explanting the LAL 100 from the patient's eye.
  • the - 0.05 mm to -1 mm SA range at a diameter of 4 mm at the LAL plane can translate to an approximately -0.1.3 mm to -2.6 mm SA range at a diameter of 6 mm in the comeal plane.
  • the SA measured at a 6 mm diameter at the comeal plane, can be in the range of -0.05 mm to -2 mm; in yet other embodiments, in the range of -0.1 mm to -0.6 mm, or in the range of -0.2 mm to -0.4 pm.
  • the SA of the combined ophthalmic optical system of the cornea 15 and the implanted LAL 100 will have an SA(combined) ::::: SA(LAL) + SA(comea), with both SA values measured at the same plane and radius.
  • SA(combined) ::::: SA(LAL) + SA(comea)
  • both SA values measured at the same plane and radius.
  • the LAL 100 is known to have a SA in the range of -0.10 mm to - 0.25 mm at a 4 mm diameter in the LAL plane
  • this SA is to be translated to a SA at a 6 mm diameter in the corneal plane.
  • the SA(LAL, d 4mm Using the translational factor of 2.6, corresponding to the average corneal power, the SA(LAL, d 4mm.
  • the SA of the combined ophthalmic optical system of the cornea 15 and the implanted LAL 100 can be determined by combining this SA(LAL, d ::: 6mm, comeal plane) with the SAicomea) of the cornea at the same 6 mm diameter in the same comeal plane: SA(combined) TM SAfLAL, d 6mm, comeal plane) + ⁇ SA(comea).
  • SA(combined) at the 6 mm diameter in the comeal plane in embodiments can be in the range of 0 mm to -0.39 mm in case of an eye with an average SA(cornea).
  • the SA( combined) can fall within the -0.05 mm to -0.5 mm range.
  • SA(combined) can fall in the -0.1 mm to -0.2 mm range.
  • SA(pre-mold) Another calculus can be useful to reconstruct SA(pre-mold), the pre-molded portion of the SA for an implanted LAL 100, where the CNA, or central region 1 10 has been already formed.
  • This SA(pre-mold) can be related to the entire LAL 100, or to the peripheral annulus 120. After the implantation of the LAL 100, the SA(pre-mold) is shifted with a ASA(CNA) by the formation of the CNA, or central region 1 10. Therefore, the SA(pre-mold) can be reconstructed by measuring the SA of the entire implanted LAL 100, and then subtracting appropriate ASA(CNA) values.
  • AS A can take values in the -0.01 mm to -0.4 mm range, in others in the -0.05 mm to -0.2 mm range.
  • the formation of the CAN, or central region 1 10 often shifts the SA(LAL) value relatively little because the diameter of the CAN, or central region 110 is often small, in the range of 0.5 mm to 1.5 mm, and the value of the spherical aberration SA scales with the fourth power of the diameter.
  • a spherical aberration caused by the position-dependence of the central optical power 114, the peripheral optical power 124, or their combination can be selected to approximately compensate a spherical aberration of the cornea 15 of the eye. fn such embodiments, the optical aberrations of the combined optical system of the cornea 15 and the LAL 100 are minimized.
  • the optical powers 1 14/124/134 often deviate substantially from a quadratic function of the radius, and thus induce higher order aberrations beyond the Z(12) spherical aberration.
  • a coma is induced when an IOL with a pre-mo Ided spherical aberration (an SA IOL) is shifted oft ' the optical axis.
  • an SA IOL a pre-mo Ided spherical aberration
  • the coma is represented by the Zernike coefficient Z8, and the spherical aberration by Z12.
  • a Ax off-axis shift of an SA IOL induces a coma given by Eq.(6):
  • Embodiments of the LAL 100 can mitigate this coma aberration, even if the LAL 100 is shifted off-axis.
  • the peripheral annulus 120 can be formed with an annulus axis 122 that is centered on the visual axis 132. In some cases, this can be achieved by shifting the annulus axis 122 with a shift that is equal and opposite to the Ax off-axis shift of the LAL 100.
  • the peripheral annulus 120 can be centered on the visual axis 132, e.g., by registering the visual axis 132 prior to dilating the iris 5.
  • the position-dependent central optical power 114 can involve a cylinder angular dependence.
  • the position-dependent peripheral optical power 124 can involve a cylinder angular dependence. Forming a cylinder in either the central region 1 10 or in the peripheral annulus 120 can mitigate an existing cylinder in the patient’s eye.
  • FIGS. 21A-B illustrate that some embodiments of the blended LALs 100 can include an annular mid-range vision region 150, positioned between the central region 1 10 and the peripheral annulus 120.
  • the mid-range optical power 154 of this mid-range vision region can be selected to improve vision at medium ranges, such as at distance around I meter.
  • An axis of the mid-range vision region 150 can coincide with the LAL axis 102, the central axis 1 12, or the annulus axis 122.
  • the mid-range vision region 150 may be viewed as part of the transition 130.
  • the first illumination 222 induces the position-dependent peripheral optical power 124
  • the second illumination 242 induces the position-dependent central optical power 1 14 primarily by inducing a shape change of the LAL 100 via activating a photopolymerization process.
  • the same illuminations 222 and 242 induce the optical powers 1 14 and 124 primarily by changing an index of refraction of the LAL 100, in effect transforming the LAL 100 into a Gradient Index of Refraction, or Graded Index of Refraction, (GR IN) lens.
  • the illuminations 222 and 242 induce the optical powers 114 and 124 by a combination of shape change and index of refraction change.
  • FIG. 22 illustrates a unifying aspect of the LALs 100b depicted in FIGS. 13-21.
  • a Light Adjustable Lens (LAL) 100b can have a LAL axis 102b, and include a light-adjusted region 31 Or, centered on an adjustment axis 312, with a position-dependent adjusted optical power 314; wherein the adjustment axis 312 can be laterally shifted relative to the LAL axis l 02b.
  • the embodiments of FIGS. 13-21 are specific embodiments of this general LAL I00b design, where, e.g. the adjusted optical power 314 includes the central optical power 1 14, the peripheral optical power 124, or both.
  • a unifying aspect of these embodiments is that, because they have an adjusted optical power 314 that was formed by adjusting the implanted LAL 100 after it settled and often shifted from its intended position in the capsular bag, the adjustment axis 312 is laterally shifted relative to the LAL. axis 102b.
  • these LALs 100b can include a lens edge 146b, a LAL rim 148b, and a LAL rim edge 149b, as in FIGS. 14A-B.
  • FIG. 23 illustrates a distinct case of a LAL 100c, where the central axis 1 12 is not shifted relative to the annulus axis 122; instead it coincides with it.
  • the central axis 1 12, the annulus axis 122 and the LAL axis 102 all coincide. This embodiment may emerge in multiple ways.
  • the visual axis 132 is determined after the iris 5 approximately returned into its non-dilated state, for example, during a subsequent office visit, and the surgeon found that none of the misalignment mechanisms ( I )-(4) shifted the LAL axis 102 from the visual axis 132, and thus the central region 1 10 can be formed centered on the shared central axis 1 12/LAL axis 102.
  • Another possibility is that for some reason, such as to reduce the number of office visits, the surgeon decides to forni the CNA/central region 1 10 while the iris 5 is still dilated, in which case it is reasonable to form the CNA/central region 1 10 with a central axis 1 12 that coincides with the annulus axis 122. All aspects, details and descriptions related to the embodiments of FIGS. 13-22 can be combined with the blended LAL 100c of FIG. 23.
  • FIGS. 24-30 describe methods of light adjustment of the blended LALs 100.
  • FIG. 24 shows that a method 200 of adjusting a Light Adjustable Lens (LAL) 100 can include the following steps.
  • LAL Light Adjustable Lens
  • an average of the central optical power 1 14 is at least 0.5 diopters different from an average of the peripheral optical power 124.
  • the average of the central optical power 1 14 can be at least 1.0 diopter different from the average of the peripheral optical power 124.
  • the average of the central optical power 114 can be at least 0.5 diopters higher than an average of the peripheral optical power 124.
  • the LALs 100 formed with such embodiments can be called Central Near Add, or CN A LALs.
  • the average of the central optical power 1 14 can be at least 0.5 diopters lower than an average of the peripheral optical power 124.
  • the LALs 100 formed with such embodiments can be called Central Distance Add (CDA), or Peripheral Near Add (PNA) LALs.
  • the applying 220 of the first illumination 222 can include applying the first illumination 222 with a first illumination pattern 224 to induce the position-dependent peripheral optical power 124 in a light-adjusted region that includes the peripheral annulus 120 and the central region 1 10.
  • the first illumination pattern 224 is concentrated mostly on the peripheral annulus 120, and an amplitude of the first illumination pattern 224 can be greatly reduced in the central region 110.
  • an advantage of the design of the blended LAL 100 is that its central axis 1 12 can be aligned with the eye’s visual axis 132.
  • the determining 230 of the central axis 1 12 can include identifying the visual axis 132 of the eye as the central axis 1 12.
  • FIGS. 25A-B illustrate that, since the iris 5 can return to its non-dilated state in an asymmetric manner, this determining step 230 of the central axis 1 12 can be performed with an iris 5 of the eye being in, or returned to, a non-dilated state in order to achieve a good alignment with the visual axis 132.
  • the eye does not need to fully return to its non-dilated state.
  • the determining 230 of the central axis 1 12 can include determining the central axis 1 12 with the iris 5 of the eye being dilated to an iris-radius no more than 30% greater than a non-dilated iris-radius. In other words, to perform the determining 230 when the iris is only in the process of returning to its non-dilated state, but the return is only partial and the iris did not reach the non-dilated state fully.
  • the determining 230 of the central axis 1 12 can include determining the central axis 1 12 before the iris 5 of the eye is dilated and registering the determined central axis 112 with a feature of the eye.
  • the determined and registered central axis 1 12 can be reconstructed after the iris is dilated, but before the applying 240 of the second illumination 242.
  • the registration of the determined central axis 1 12 can be carried out with respect to retinal features, in other cases, with respect to features of the iris, limbus, or sclera of the eye.
  • the determining of the central axis 1 12 can involve determining the visual axis 132 of the eye with the iris 5 being non-dilated, and then simply defining the central axis 112 as the determined visual axis 132.
  • An advantage of this approach is that the doctor does not have to wait during the surgery for the iris 5 to slowly return to its largely non-dilated state; or, does not have to schedule a separate subsequent procedure to apply the second illumination 242.
  • the sequence of the applying 220 of the first illumination 222 and the applying 240 of the second illumination 242 can be interchanged, since the availability of the registered central axis 112 eliminates the need to wait for the iris 5 to relax after the applying 220.
  • the sequence of the applying step 220 and the applying step 240 can be also interchanged in embodiments of the method 200 where the iris 5 is dilated not at the beginning of the procedure, but only after the firstly-performed applying 240 of the second illumination 242 has been completed.
  • the applying 240 of the second illumination 242 can be performed before the applying 220 of the first illumination 222, both with the iris dilated. In these embodiments, it may be somewhat challenging to align the central axis 1 12 with the visual axis 132.
  • the applying 220 of the first illumination 222 and the applying 240 of the second illumination 242 can induce a transition 130 between the central region i 10 and the peripheral annulus 120, having a transition optical power 134 that changes from the central optical power 1 14 to the peripheral optical power 124.
  • FIG. 16 illustrates that the method 200 can be performed to create“flat top” blended LALs 100.
  • the central optical power 1 14 can have an approximately flat position-dependence, having an optical power variation less than 0.2 diopters over a central 50% of the central region 110.
  • the central optical power can have an optical power variation greater than 0.2 diopters over the central 50% of the central region
  • the central optical power 1 14 can be a quadratic function of the radius from the central axis 1 12 over a quadratic central region, optionally having a small correction term. As described in relation to Eq. (5), such a quadratic radius dependence of the optical power induces a fourth order spherical aberration, discussed further below.
  • the peripheral optical power 124 can have an approximately flat position-dependence, having an optical power variation less than 0.2 diopters over 50% of the peripheral annulus 120.
  • the peripheral optical power 124 can be a function of a radius from the annulus axis 122, having an optical power variation greater than 0.2 diopters over 50% of the peripheral annulus 120.
  • the peripheral optical power 124 can be a quadratic function of the radius from the annulus axis 122 over a quadratic annular region, optionally with a small correction term.
  • the mentioned quadratic radius dependence of the peripheral optical power 124 can also induce, or cause, a spherical aberration (SA) in the -0.05 mm to -1 mm range at a diameter of 4 mm in a plane of the LAL 100.
  • SA spherical aberration
  • the spherical aberration caused by the position-dependence of the peripheral optical power 124 can be in the -0.10 mm to -0.25 mm range at a diameter of 4 mm in a plane of the LAL 100.
  • SA values can be translated into corneal plane, d-6 mm SA values with a translation factor, which in a wide class of cases is about 0.26, as calculated earlier.
  • At least one of the central optical power 1 14 and the peripheral optical power 124 can be selected such that a spherical aberration caused by the position-dependence of the selected central optical power 1 14 or peripheral optical power 124 approximately compensates a spherical aberration of the cornea 15 of the eye.
  • a selection can minimize, or even eliminate, the i nducing of aberrations in the eye's optical system, by a postsurgical shift of the LAL 100.
  • the applying 220 of the first illumination 222, or the applying 240 of the second illumination 242 can further include inducing the position- dependent central optical power 1 14 with a cylinder angular dependence, or inducing the position-dependent peripheral optical power 124 with a cylinder angular dependence.
  • These embodiments of the method 200 can mitigate not only presbyopia, but also cylinder aberrations of the eye.
  • the inducing of a cylinder in the central region 1 10 or in the peripheral annulus 120 can be performed before, simultaneously, or after the applying steps 220 or 240.
  • the numerous sequences and combinations of the (1) applying 220 of the first illumination 222; (2) applying 240 of the second illumination; and (3) inducing the cylinder, can all be embodiments of the method 200.
  • the applying 220 of the first illumination 222 and the applying 240 of the second illumination 242 can be separated by less than 48 hours. In some embodiments, these two applying steps 220 and 240 can even be performed as part of a single, integrated procedure, separated by only a short time, thus reducing the demands on the surgeon and the patient.
  • a lock-in illumination can be applied to the LAL 100, in order to lock in the induced peripheral optical power 124 and the induced central optical power 1 14 in the LAL 100.
  • Phis step can be necessary to lock in the specific shape of the LAL 100 by de-activating all remaining photopolymerizable macromers still in the LAL 100, as described, e.g., in the incorporated US Patents 6,905,641 , to Platt et al, and in 7.281,795, to Sandstedt et al., among others.
  • FIG. 26 and FIGS. 27A-B illustrate an additional advantage of the method 200.
  • the patient may ask the surgeon to form the CNA central region 1 10 in the implanted LAL 100, but after the procedure may be dissatisfied w ith the outcome and demand a corrective procedure. This can happen if the CNA central region 1 10 caused undesired or disorienting blurriness, or halos, or both.
  • the surgeon implanted a non-iight-adjustable CNA IOL, such a patient demand would be impossible to satisfy.
  • having implanted a blended LAL 100 enables the surgeon to perform a“CNA erasure” process.
  • FIG. 27A* left panel re-describes the LAL 100 as formed by the steps 210-260 of the method 200.
  • FIG. 27 A, right panel illustrates that performing of the additional applying step 270 of the third illumination 272 to reduce the central optical power 1 14. This reduction is captured, e.g., in that the optical power change 1.36 between the central optical power 1 14 and the peripheral optical power 124 is visibly reduced by the applying 270 of the third illumination 272.
  • FIG. 27.4, central panel shows a third illumination pattern 274 that is intense in the peripheral annulus 120 but has low intensity in the central region 1 10, and therefore can be suitable for the applying 270 of the third illumination 272.
  • FIG. 27B illustrates that the applying the third illumination 272 can largely restore the patient's visual acuity.
  • the plot shows an often-used measure of visual acuity, the Modulation Transfer Function, or MTF, as a function of its natural variable, the frequency, measured in line pairs per mm, or Ip/mm.
  • MTF Modulation Transfer Function
  • the MTF gets reduced from its value prior to the second illumination 242 that formed the CNA central region 1 10 to lower values after the second illumination 242, since the C.NA central region 1 10, while it improves the patient’s near vision, it also enhances optical various aberrations. The reduction is more pronounced at higher frequencies.
  • the plot demonstrates that the MTF can be restored to essentially the pre-second-illumination levels by applying of the third illumination 272.
  • the patient may be dissatisfied with the outcome and demand a corrective procedure, but with an opposite goal.
  • the patient may report to the doctor no visual acuity problems caused by the CNA central region 1 10, but instead may find that not enough power was added.
  • the third illumination 272 may be used with a third illumination pattern 274 to enhance the central optical power 1 14 in the central region 1 10.
  • FIG. 28 illustrates a method 300 of adjusting the Light Adjustable Lens (LAL) 100, related to the method 200.
  • the method 300 can comprise the following steps. - Implanting 310 a LAL 100 into an eye, the LAL 100 having a pre-molded position- dependent peripheral optical power 124 in at least a peripheral annulus 120, centered on an annulus axis 122;
  • the central axis 1 12 is laterally shifted relative to the annulus axis 122, and
  • An average of the central optical power 114 is at least 0.5 diopters different from than an average of the peripheral optical power 124.
  • a difference between the method 200 and this method 300 is the manner in which the position dependent peripheral optical power 124 is formed.
  • the peripheral optical power 124 is formed by the applying 220 of the first illumination 222 to the already implanted LAL 100.
  • this same peripheral optical power 124 is pre-formed, prior to the implantation of the 1AL i 00, during the molding process of the manufacture of the LAL 100.
  • a benefit of the method 200 is that the positioning and the magnitude of the peripheral annulus 120 can be adjusted based on a measurement of the postsurgicai shifts of the LAL 100.
  • Another benefit is that the magnitude and position dependence of the peripheral optical power 124 can be customized to the individual need of the specific patient.
  • a drawback can be that doing so may require an additional procedure, with the necessary scheduling and organization and an extra trip for the patient. (It is noted that this demand can be reduced in some cases by performing the applying step 220 and the applying step 240 during a single visit by the patient. This may require accelerating the iris 5 returning to its non-dilated state by pharmacological means.)
  • benefits of the method 300 include that it starts with a LAL 100 that already has a pre-molded position-dependent peripheral optical power 124. In a sense, this method 300 starts with an EDOF LAL, and the method concentrates on adding a CN A to this EDOF LAL. Therefore, the method 300 does not require the applying 220 of the first illumination 222, and thus has one less procedure step. This beneficially reduces the number of office visits for the patient.
  • Potential drawbacks include that the positioning of the peripheral annulus 120 and the magnitude of the peripheral optical power 124 may not be adjusted in response to a measurement of the postsurgicai shift of the LAL 100.
  • embodiments of the LAL 100 that combine a pre-molded optical power 124 with a radial variation of 0.5-1 D with a customized addition of 1-2D of central optical power 1 14 post implantation, may be able to deliver all the benefits of the blended CNA+EDOF LAL designs, even without customizing the peripheral optical power 124 by applying 220 the first illumination 222 post-implantation.
  • surgeons may be provided with a series of LALs with different amounts of radial peripheral optical power variations, and thus different SAs, pre-molded into them. This may enable the surgeon to select a LAL with the pre-molded SA and position dependent peripheral optical power 124 that is most suitable for the patient’s individual need. All in all, both the method 200 and the method 300 have advantages and drawbacks, and the surgeon may decide between them based on the needs of the individual patient.
  • the position dependence of the peripheral optical power 124 can be pre-molded on the front of the LAL 100, on its back, or in combination both in the front and in the back.
  • FIG. 29 illustrates that the above two methods, method 200 and method 300 can be thought of as subcases of a more generally articulated method 400 of adjusting the Light Adjustable Lens (LAL) 100.
  • the generalized method 400 can comprise the following steps.
  • an LAL 100 implanted into an eye, to induce a first depth of focus in an ophthalmic optical system, i.e. the optical system of the eye with its cornea and the implanted LAL 100;
  • the second depth of focus is at least 0.5 diopters greater than the first depth of focus.
  • Steps 420-450 can be analogous to the steps 230-260 of the method 200, with appropriate modifications in the last step.
  • the causing step 410 can include the applying 220 of the first illumination 222 to the LAL 100, in analogy to step 220 of the method 200.
  • the causing step 410 can include providing a LAL 100 with a pre-molded depth of focus in analogy to step 310 of method 300. The pre molded depth of focus can be induced by a position-dependent peripheral optical power 124 in the peripheral annulus 120, centered on the annulus axis 122.
  • the causing step 410 may involve a combination of the steps 220 and 310.
  • FIG.30 illustrates a method 500 of adjusting the Light Adjustable Lens (LAL) 100, primarily as shown in FIG. 22.
  • the method 500 can include the following steps.
  • the adjustment axis 312 is laterally shifted relative to the LAL axis 102b.
  • Camellin M Calossr A. A new formula for intraocular lens power calculation after refractive comeal surgery. J Refract Surg. 2006; 22(2): 187-99.
  • Ciuffreda Accommodation, the Pupil, and Presbyopia, Chapter 4 in Borisch's Clinical Refraction pp. 77-120, W.B. Saunders Company ( 1998).
  • Fam HB Lim KL. A comparative analysis of intraocular lens power calculation methods after myopic excimer laser surgery. J Refract Surg. 2008; 24:355-360. [0297] Feiz V, Moshirfar M, Mannis MJ, Reilly CD, Garcia-Ferrer F, Caspar JJ, Lim MC. Nomogram-based intraocular lens power adjustment after myopic photorefractive keratectomy and LASIX. Ophthalmology 2005; 1 12: 1381-1387.

Abstract

Une lentille ajustable par la lumière (LAL) comprend une région centrale, centrée sur un axe central, ayant une puissance optique centrale dépendant de la position, et un anneau périphérique, centré sur un axe annulaire et entourant la région centrale, ayant une puissance optique périphérique dépendant de la position; dans cette lentille, la puissance optique centrale est diéérente d'au moins 0,5 dioptries d'une moyenne de la puissance optique périphérique, et l'axe central est décalé latéralement par rapport à l'axe annulaire; un procédé de réglage de la LAL comprend l'implantation d'une LAL; l'application d'une première irradiation à la LAL avec un premier diagramme d'irradiation pour induire une puissance optique périphérique dépendante de la position dans au moins un anneau périphérique, centré sur un axe annulaire; la détermination d'une région centrale et d'un axe central correspondant de la LAL; et l'application d'une seconde irradiation à la LAL avec un second diagramme d'irradiation pour induire une puissance optique centrale dépendante de la position dans la région centrale de la LAL.
PCT/US2019/069170 2018-12-31 2019-12-31 Procédé d'ajustement d'une profondeur étendue mixte de lentille ajustable par la lumiere à axes décalés latéralement WO2020146177A2 (fr)

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US16/236,659 US11135052B2 (en) 2011-09-16 2018-12-31 Method of adjusting a blended extended depth of focus light adjustable lens with laterally offset axes
US16/236,659 2018-12-31

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