Patent application title: Accommodating Intraocular Lens
John H. Shadduck (Tiburon, CA, US)
IPC8 Class: AA61F216FI
Class name: Eye prosthesis (e.g., lens or corneal implant, or artificial eye, etc.) intraocular lens having means on lens to reduce overall dimension of lens for insertion into small incision
Publication date: 2010-09-09
Patent application number: 20100228344
A deformable intracapsular implant device for shaping an enucleated lens
capsule sac for use in cataract procedures and refractive lensectomy
procedures. In one embodiment, the intraocular implant devices rely on
thin film shape memory alloys and combine with the post-phaco capsular
sac to provide a biomimetic complex that can mimic the energy-absorbing
and energy-releasing characteristics of a young accommodative lens
capsule. In another embodiment, the capsular shaping body is combined
with an adaptive optic. The peripheral capsular shaping body carries at
least one fluid-filled interior chamber that communicates with a space in
a adaptive optic portion that has a deformable lens surface. The flexing
of the peripheral shaping body in response to zonular tensioning and
de-tensioning provides an inventive adaptive optics mechanism wherein
fluid media flows between the respective chambers "adapts" the optic to
increase and decrease the power thereof. In one embodiment, the capsular
shaping body carries a posterior negative power adaptive optic that can
be altered in power during accommodation to cooperate with an independent
drop-in exchangeable intraocular lens.
1. A method of providing an accommodative response to ciliary muscle
movement in an eye, comprising:an accommodating intraocular lens
comprising an optic portion that refracts light;rolling or folding the
intraocular lens;introducing the rolled or folded intraocular lens into
the eye through a small incision in the eye; andproviding accommodation
to the intraocular lens by allowing a refractive element of the optic
portion to change curvature in response to ciliary muscle movement.
2. The method of claim 1 wherein allowing a refractive element of the optic portion to change curvature in response to ciliary muscle movement comprises allowing fluid to flow between a peripheral non-optic portion of the intraocular lens and the optic portion in response to ciliary muscle movement to change the curvature of the refractive element.
3. The method of claim 1 wherein allowing a refractive element of the optic portion to change curvature in response to ciliary muscle movement comprises allowing an anterior-most surface of the optic portion to change curvature in response to ciliary muscle contraction.
4. The method of claim 3 wherein allowing an anterior-most surface of the optic portion to change curvature in response to ciliary muscle movement comprises allowing a fluid to flow between a peripheral non-optic portion of the intraocular lens and a fluid chamber in the optic portion in response to ciliary muscle movement.
5. The method of claim 3 wherein allowing an anterior-most surface of the optic portion to change curvature in response to ciliary muscle movement comprises allowing the anterior-most surface of the optic portion to increase in curvature in response to ciliary muscle movement.
6. The method of claim 1 wherein introducing the rolled or folded intraocular lens into the eye comprises introducing the intraocular lens into a lens capsule.
7. The method of claim 6 wherein allowing a refractive element of the optic portion to change curvature in response to ciliary muscle movement comprises allowing the refractive element to change curvature in response to forces applied to a peripheral portion of the intraocular lens by the capsule in response to ciliary muscle movement.
8. An accommodating intraocular lens, comprising:a deformable optic portion adapted to refract light, wherein the optic portion is adapted to be folded or rolled for insertion into an eye through a small incision,wherein the optic portion comprises a refractive element adapted to change curvature in response to ciliary muscle movement to provide accommodation after unfolding or unrolling in the eye.
9. The accommodating intraocular lens of claim 8 further comprising a peripheral non-optic portion extending peripherally from the optic portion.
10. The accommodating intraocular lens of claim 9 wherein the peripheral non-optic portion is sized to fit within and engage with a lens capsule, and is further adapted to deform in response to ciliary muscle movement to change the curvature of the refractive element.
11. The accommodating intraocular lens of claim 8 further comprising a non-optic portion comprising a fluid chamber, wherein the optic portion comprises a fluid chamber in communication with the non-optic portion fluid chamber, and wherein the non-optic portion is adapted to respond to forces thereon to transfer fluid between the non-optic portion chamber and the optic portion chamber to change the curvature of the refractive element.
12. The accommodating intraocular lens of claim 11 wherein the non-optic portion comprises a plurality of haptics, wherein each of the haptics comprises a chamber in fluid communication with the fluid chamber in the optic portion.
13. The accommodating intraocular lens of claim 8 further comprises a non-optic peripheral portion extending from the optic portion, wherein the peripheral non-optic portion has a thickness along the optical axis greater than a thickness of the optic portion along the optical axis.
14. The accommodating intraocular lens of claim 13, wherein the non-optic peripheral portion comprises a plurality of discrete haptics, and wherein each of the plurality of discrete haptics has a thickness along the optical axis that is greater than the thickness along the optical axis of the optic portion.
15. The accommodating intraocular lens of claim 13 wherein the non-optic peripheral portion is sized to fit within a lens capsule.
CROSS-REFERENCE TO RELATED APPLICATIONS
This application is a continuation of pending U.S. application Ser. No. 10/358,038, filed Feb. 3, 2003, titled "Intraocular Implant Devices", which claims benefit under 35 U.S.C. §119(e) of Provisional Patent Application No. 60/353,847 filed Feb. 2, 2002 titled "Intraocular Lens and Method of Making"; and also claims benefit of the following other Provisional Patent Applications: No. 60/362,303 filed Mar. 6, 2002 titled "Intraocular Lens and Method of Making"; No. 60/378,600 filed May 7, 2002 titled "Intraocular Devices and Methods of Making"; No. 60/405,471 filed Aug. 23, 2002 titled "Intraocular Implant Devices and Methods of Making", No. 60/408,019 filed Sep. 3, 2002 titled "Intraocular Lens", and No. 60/431,110 filed Dec. 4, 2002 titled "Intraocular Implant Devices and Methods of Making". All of the above applications are incorporated herein in their entirety by this reference.
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention is directed to intraocular implant devices and more specifically to shape memory capsular shaping devices for combining with a post-phacoemulsification capsular sac to provide a biomimetic complex that can mimic the energy-absorbing and energy-releasing characteristics of a natural young accommodative lens capsule. The shape memory capsular shaping devices can further be combined with an independent or integrated optics to provide an accommodating intraocular lens.
2. Description of the Related Art
The human lens capsule can be afflicted with several disorders that degrade its functioning in the vision system. The most common lens disorder is a cataract which consists of the opacification of the normally clear, natural crystalline lens matrix in a human eye. The opacification usually results from the aging process but can also be caused by heredity or diabetes. FIG. 1A illustrates a lens capsule comprising a capsular sac with an opacified crystalline lens nucleus. In a typical cataract procedure as performed today, the patient's opaque crystalline lens is replaced with a clear lens implant or IOL. (See FIGS. 1A and 1B.) The vast majority of cataract patients must wear prescription eyeglasses following surgery to see properly. The IOLs in use today provide the eye with a fixed focal length, wherein focusing on both close-up objects and distant objects is not possible. Intraocular lens implantation for cataracts is the most commonly performed surgical procedure in elderly patients in the U.S. Nearly three million cataract surgeries are performed each year in the U.S., with an additional 2.5 million surgeries in Europe and Asia.
Mechanisms of Accommodation. Referring to FIG. 1A, the human eye defines an anterior chamber 10 between the cornea 12 and iris 14 and a posterior chamber 20 between the iris and the lens capsule 102. The vitreous chamber 30 lies behind the lens capsule. The lens capsule 102 that contains the crystalline lens matrix LM or nucleus has an equator that is attached to cobweb-like zonular ligaments ZL that extend generally radially outward to the ciliary muscle attachments. The lens capsule 102 has transparent flexible anterior and posterior walls or capsular membranes that contain the crystalline lens matrix LM.
Accommodation occurs when the ciliary muscle CM contracts to thereby release the resting zonular tension on the equatorial region of the lens capsule 102. The release of zonular tension allows the inherent elasticity of the lens capsule to alter it to a more globular or spherical shape, with increased surface curvatures of both the anterior and posterior lenticular surfaces. The lens capsule together with the crystalline lens matrix and its internal pressure provides the lens with a resilient shape that is more spherical in an untensioned state. Ultrasound biomicroscopic (UBM) images also show that the apex of the ciliary muscle moves anteriorly and inward--at the same time that the equatorial edge the lens capsule moves inwardly from the sclera during accommodation.
When the ciliary muscle is relaxed, the muscle in combination with the elasticity of the choroid and posterior zonular fibers moves the ciliary muscle into the unaccommodated configuration, which is posterior and radially outward from the accommodated configuration. The radial outward movement of the ciliary muscles creates zonular tension on the lens capsule to stretch the equatorial region of lens toward the sclera. The disaccommodation mechanism flattens the lens and reduces the lens curvature (both anterior and posterior). Such natural accommodative capability thus involves contraction and relaxation of the ciliary muscles by the brain to alter the shape of the lens to the appropriate refractive parameters for focusing the light rays entering the eye on the retina--to provide both near vision and distant vision.
In conventional cataract surgery as depicted in FIGS. 1B and 1C, the crystalline lens matrix is removed leaving intact only the thin walls of the anterior and posterior capsules--together with zonular ligament connections to the ciliary muscles. The crystalline lens core is removed by phacoemulsification through a curvilinear capsularrhexis as illustrated in FIG. 1B, i.e., the removal of an anterior portion of the capsular sac. FIG. 1B then depicts a conventional 3-piece IOL just after implantation in the capsular sac.
FIG. 1C next illustrates the capsular sac and the prior art 3-piece IOL after a healing period of a few days to weeks. It can be seen that the capsular sac effectively shrink-wraps around the IOL due to the capsularrhexis, the collapse of the walls of the sac and subsequent fibrosis. As can be easily understood from FIGS. 1B and 1C, cataract surgery as practiced today causes the irretrievable loss of most of the eye's natural structures that provide accommodation. The crystalline lens matrix is completely lost--and the integrity of the capsular sac is reduced by the capsularrhexis. The shrink-wrap of the capsular sac around the IOL damages the zonule complex, and thereafter it is believed that the ciliary muscles will atrophy.
Prior Art Pseudo-Accommodative Lens Devices. At least one commercially available IOL, and others in clinical trials, are claimed to "accommodate" even though the capsular sac shrink-wraps around the IOL as shown in FIG. 1C. If any such prior art lens provide variable focusing power, it is better described as pseudo-accommodation since all the eye's natural accommodation mechanisms of changing the shape of the lens capsule are not functioning. Perhaps the most widely known of the pseudo-accommodative IOLs is a design patented by Cumming which is described in patent disclosures as having hinged haptics that are claimed to flex even after the capsular sac is shrink-wrapped around the haptics. Cumming's patents (e.g., U.S. Pat. Nos. 5,496,366; 5,674,282; 6,197,059; 6,322,589; 6,342,073; 6,387,126) describe the hinged haptics as allowing the lens element to be translated forward and backward in response to ciliary muscle contraction and relaxation within the shrink-wrapped capsule. The Cumming IOL design is being commercialized by C&C Vision, 6 Journey, Ste. 270, Aliso Viejo, Calif. 92656 as the CrystaLens AT-45. However, the medical monitor for the CrystaLens AT-45 in Phase I FDA trials explained in an American Society of Cataract and Refractive Surgeons (ASCRS) presentation, when asked about movement of AT-45's hinged haptics, that the AT-45 was not "moving much" at the optic and hinge. It is accepted that the movement of such a lens is entirely pseudoaccommodative and depends on vitreous displacement that pushes the entire IOL slightly anteriorly (see: http://www.candcvision.com/ASCRSCCTa-lks/Slade/Slade.htm). A similar IOL that is implanted in a shrink-wrapped capsule and in sold in Europe by HumanOptics, Spardorfer Strasse 150, 90154 Erlangen, Germany. The HumanOptics lens is the Akkommodative 1CU which is not available in the U.S., due to lack of FDA approval. In sum, any prior art IOLs that are implanted in an enucleated, shrink-wrapped lens capsule probably are not flexed by ciliary muscle relaxation, and exhibit only a pseudo-accommodative response due to vitreous displacement.
Since surgeons began using IOLs widely in the 1970's, IOL design and surgical techniques for IOL implantation have undergone a continuous evolution. While less invasive techniques for IOL implantation and new IOL materials technologies have evolved rapidly in the several years, there has been no real development of technologies for combining the capsular sac with biocompatible materials to provide a biomimetic capsular complex. What has stalled all innovations in designing a truly resilient (variable-focus) post-phaco lens capsule has been is the lack of sophisticated materials.
What has been needed are materials and intraocular devices that be introduced into an enucleated lens capsule with a 1 mm. to 2.5 mm. injector, wherein the deployed device and material provide the exact strain-absorbing properties and strain-releasing properties needed to cooperate with natural zonular tensioning forces. Such an intraocular device will allow for the design of dynamic IOLs that can replicate natural accommodation. Microdevices of intelligent elastic composite materials can provide the enabling technology to develop new classes of accommodating IOL systems.
SUMMARY OF THE INVENTION
This invention relates to novel shape memory devices, materials and capsular shaping elements (CSEs) that can be implanted using conventional techniques to create a biomimetic lens capsule complex. The capsular shaping element, or more specifically an intracapsular implant, is designed to provide the implant/lens capsule complex with a shape and resiliency that mimics the elasticity of a young, still-accommodative lens capsule. In one embodiment, the capsular shaping element incorporates at least one thin-film expanse of a shape memory alloy (SMA) material in a three dimensional shape to impart the required elasticity to the CSE. The capsular shaping element will enable, and can be integrated with, several classes of optic elements to provide an accommodative IOL system that cooperates with ciliary muscle tensioning and detensioning to provide variable focusing power. The accommodating IOL corresponding to the invention can be used following typical cataract surgeries, or can be used in refractive lensectomy procedures to treat presbyopia.
In a preferred embodiment, the capsular shaping element incorporates a least one formed expanse of thin-film nickel titanium alloy (NiTi or Nitinol). Nitinol materials have the unique capability to absorb energy by a reversible crystalline transformation (superelasticity) which is orders of magnitude higher than can be absorbed in plastic deformations of conventional resilient materials, such as a polymers used in other so-called accommodating IOL designs. In addition, such NiTi materials have the ability to avoid localization of plastic deformations--and thus can spread the absorbed energy over a much larger region of the material. Further, a capsular shaping element that relies on NiTi for its shape memory characteristics need only be microns in thickness for compacted introduction into the lens capsule. The implant, in fact, may be little thicker than the lens capsule itself. Nickel titanium alloys are also known to be biocompatible. In preferred variants of biomimetic CSEs described herein, the implant carries at least one seamless expanse of thin-film NiTi material that three dimensionally formed to engage the anterior and posterior capsules--while leaving an open central optic zone. Various types of optic elements can be coupled to the capsular shaping element of the invention.
In such preferred embodiments, the capsular shaping body also comprises in part a shape memory polymer (SMP) component that encases the shape memory alloy form, whether of a thin film SMA or another formed structure of a nickel titanium alloy. The shape memory polymer is capable of a memory shape as well as a compacted temporary shape. In its temporary compacted shape, the polymer together with the embedded superelastic nickel titanium can be ultrathin and three dimensionally stable to be rollable for use in standard diameter injector or even a sub-1 mm. injector.
In another preferred embodiment, the non-optic or peripheral body portion of the implant is again of a shape memory polymer, and optional SMA form, that engages the enucleated lens capsule to provide a post-phaco biomimetic complex that mimics the energy-absorbing and energy-releasing characteristics of an accommodative lens capsule. An adaptive lens element is coupled to the annular peripheral body portion. In this embodiment, the peripheral capsular shaping portion of the implant body carries at least one fluid-filled interior chamber that communicates with a central chamber in the adaptive lens element that actuates a deformable surface thereof. The flexing of the peripheral body portion in response to zonular tensioning and de-tensioning provides an adaptive optic mechanism wherein fluid media flows between the respective chambers to deform the lens surface to increase or decrease lens power. For example, in one embodiment, the peripheral body portion carries a posterior negative power lens that can be altered in power during accommodation to cooperate with a second lens element to provide variable focus.
Accordingly, a principal advantage of the present invention is the provision of deformable, rollable intraocular devices such as capsular shaping devices that utilize shape memory alloy forms, such shaping devices enabling an artificial lens system to provide accommodative amplitude (diopters of power modification).
The invention advantageously provides a capsular shaping element with integrated optics that require only a very small entry incision for implantation--for example a sub-1 mm. minimal incision through the cornea.
The invention advantageously provides an independent module comprising a capsular shaping structure of a thin film material that conforms to and maintains an intracapsular volume for receiving an IOL.
The invention provides a capsular shaping structure of a superelastic shape memory alloy form within a shape memory polymer envelope that conforms to and maintains an intracapsular volume.
The invention advantageously provides an independent module comprising a capsular shaping structure that can cooperate with drop-in fixed focus IOL or a drop-in accommodating IOL.
The invention advantageously provides an independent module comprising a capsular shaping element that allows for simplified lens exchange.
The invention provides an independent module comprising a capsular shaping structure that is adapted to cooperate with, and amplify, zonular tensioning and de-tensioning caused by ciliary muscle relaxation and contraction to enable various types of an accommodating lens systems.
The invention advantageously provides a modular capsular shaping element that is adapted to cooperate with both (i) vitreous displacement caused by ciliary muscle contraction; and (ii) zonular tensioning and de-tensioning caused by ciliary muscle relaxation and contraction, to amplify lens translation in a novel types of accommodating lens systems.
The invention provides an IOL with optic or non-optic body portions that carry a photomodifiable SMP that can be irradiated to adjust an operational parameter of an adaptive optic or accommodating lens system.
The invention provides an IOL with a polymer non-optic body portion that carries an anti-fibrotic pharmacological agent for release about the capsular sac for preventing or limiting fibrosis and shrinkage of the capsular sac.
These and other objects of the present invention will become readily apparent upon further review of the following drawings and specification.
BRIEF DESCRIPTION OF THE DRAWINGS
In order to better understand the invention and to see how it may be carried out in practice, some preferred embodiments are next described, by way of non-limiting examples only, with reference to the accompanying drawings, in which like reference characters denote corresponding features consistently throughout similar embodiments in the attached drawings.
FIG. 1A is a perspective cut-away view of an eye with an opacified lens capsule.
FIG. 1B is a perspective cut-away view of the eye of FIG. 1A with a curvilinear capsularrhexis and the crystalline lens matrix removed by phacoemulsification, together with the implantation of a prior art 3-piece IOL.
FIG. 1C is a perspective cut-away view of the eye of FIG. 1B showing the lens capsule after wound healing wherein the lens capsule shrink-wraps around the prior art IOL.
FIG. 2 is a stress-strain graph of the thin-film superelastic nickel titanium alloy that is utilized in a preferred embodiments of the invention.
FIG. 3A is a schematic depiction of the crystalline lattice of the thin-film superelastic nickel titanium alloy of FIG. 2 in a martensite state.
FIG. 3B is a depiction of the crystalline lattice of the superelastic nickel titanium alloy of FIG. 3A in its memory austhenite state.
FIG. 4 is a perspective cut-away view of a lens capsule and Type "A" intraocular device corresponding to the invention comprising a deformable, rollable ultrathin capsular shaping element (CSE) of a thin-film expanse of shape memory material encased in a polymer.
FIG. 5 is a perspective cut-away view of the lens capsule of FIG. 4 that illustrates anterior and posterior engagement planes of the capsule that targeted for engagement by the Type "A" capsular shaping element (CSE) of FIG. 4.
FIG. 6 is a cut-away view of an alternative Type "A" capsular shaping element similar to that of FIG. 4 with a posterior annular body portion of a polymer.
FIG. 7 is a cut-away partial view of another alternative Type "A" capsular shaping element similar to that of FIGS. 4 and 6; this embodiment configured to provide additional stress-absorbing features and a non-elliptical equatorial region for allowing slight shrinkage of the lens capsule.
FIG. 8A is a schematic sectional view of a post-phaco lens capsule with its equatorial envelope after being shaped by the implant of FIG. 4 or FIG. 6.
FIG. 8B is a schematic sectional view of a post-phaco lens capsule with its equatorial envelope after being shaped by the implant of FIG. 7 wherein the equatorial region is non-elliptical after capsule shrinkage to reduce laxity in the zonular ligaments.
FIG. 9 is a cut-away view of an alternative Type "A" capsular shaping implant that comprises an elastic composite structure for creating enhanced stress-bearing capacity.
FIG. 10 is a cut-away view of an alternative Type "A" capsular shaping element that carries a biodegradable SMP or shape memory polymer for automatically altering the stress-bearing capacity of the implant following the wound healing response.
FIG. 11 is a cut-away view of another Type "A" capsular shaping element that carries an adjustable shape memory polymer (SMP) that responds to stimulus from a remote source for altering the stress-bearing capacity of the implant in the post-implant period.
FIG. 12 is a cut-away view of Type "A" composite capsular shaping body of a thin-film shape memory alloy and an outer polymer envelope.
FIGS. 13A-13B are sectional schematics of a Type "B" capsular shaping element with integrated optic element showing disaccommodative and accommodative positions, respectively.
FIG. 14 is a cut-away view of the Type "B" IOL of FIGS. 13A-13B.
FIGS. 15A-15B are sectional schematics of another Type "B" capsular shaping element with integrated fluid-filled adaptive optic element.
FIG. 15C is a view of another Type "B" capsular shaping body with and integrated gel-filled optic element that substantially occupies the volume of the capsular sac.
FIG. 16A is a sectional view of another Type "B" capsular shaping element with a posterior negative power adaptive lens element with fluid displacement means for altering the lens power.
FIG. 16B is a perspective view of the implant device of FIG. 16A.
FIG. 17 is a view of a Type "B" intraocular device of FIG. 16A showing a method of rolling the device for introduction into the eye, the body of a shape memory polymer (SMP) encasing a shape memory alloy form.
FIG. 18 is an exploded view of the two components of the device of FIG. 16A, showing flow channels between the interior chambers of the peripheral non-optic portion and the optic portion.
FIG. 19 is a sectional view of an alternative intraocular device similar to FIG. 16A showing a drop-in IOL in phantom view engaged with the implant device of FIG. 16A.
FIG. 20A is a sectional view of the intracapsular device of FIG. 16A at, or urged toward, its memory shape as when implanted in a capsular sac.
FIG. 20B is a sectional view of the intracapsular device of FIG. 20A deformed toward a temporary shape showing a flow of fluid from the peripheral non-optic portion to the optic portion to alter the power of the lens.
FIG. 21 is a sectional view of a capsular shaping body and adaptive bi-convex optic with communicating peripheral and central chamber portions showing accommodative and disaccommodative shapes.
FIG. 22 is a cut-away view of an alternative intraocular device similar to FIG. 16A illustrating a plurality of regions of a shape memory polymer adjacent to an interior space that are responsive to an external energy source to alter fluid flows and the dynamics of fluid displacement in the optic portion.
FIG. 23 is a perspective illustration of a capsular shaping system that utilizes first and second cooperating independent devices (in an accommodative shape), each similar to the device of FIG. 16A, one device for engaging the posterior capsule and a limited equatorial capsular region and the second device adapted for engaging only the anterior capsule and a limited equatorial region.
FIG. 24 is a perspective view of capsular shaping system of FIG. 23 with the cooperating independent devices in a disaccommodative shape.
FIG. 25 is a sectional view of an alternative intracapsular implant and adaptive optic with a shape memory polymer peripheral body that carries and interior fluid-filled chamber.
FIG. 26 is a sectional view of an alternative intracapsular implant and adaptive optic similar to that of FIG. 25 with alternative interior chamber locations.
FIG. 27 is a sectional view of an alternative intracapsular implant and adaptive optic similar to that of FIG. 26.
FIG. 28 is a sectional view of an alternative intracapsular implant with first and second adaptive optic elements that is similar to that of FIG. 25.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
Principles of Superelasticity and Shape Memory in Classes of Ophthalmic Implant Materials
The capsular shaping element (CSE) of the invention is adapted for providing a biomimetic lens capsule complex that will enable an accommodative lens system, which can have several variants. The term biomimetic lens capsule is derived from the word biomimesis, which defines the development of structures that mimic life, or that imitate biological systems. In this case, the objective is to develop an implant that mimics the inherent elasticity of a young lens capsule for cooperating with the ciliary muscle to alter the shape or translation of an implanted optic element.
The biomimetic lens capsules corresponding to the invention are enabled by the phenomena of shape memory and superelasticity that are unique to certain newly developed so-called intelligent materials. In particular, one embodiment of CSE comprises a thin-film expanse of a nickel titanium alloy that is fabricated in a vacuum chamber deposition process. The nickel titanium form is embedded within a thin biocompatible polymer envelope. In the prior art, the principal uses of nickel titanium alloys have been developed from uniaxial models of superelasticity, such as in wires and other bulk materials. The invention extends the use of nickel titanium fabricated in thin film expanses. Additional embodiments comprise, at least in part, an expanse of a shape memory polymer (SMP), a shape memory polymer foam, or a bioerodible shape memory polymer.
In order to understand the invention, it is useful to describe the phenomena of shape memory and superelasticity that are unique to nickel titanium alloys, which are utilized in preferred embodiments of the capsular shaping structures of the invention. In an unstressed state, the nickel titanium alloy component will present itself in an austhenite phase--in which phase it exhibits linear elasticity. When stress is applied to the material, the austhenite phase transforms into a martensite phase that also exhibits linear elasticity, however, each phase has a different constant as can be seen in FIG. 2. The austhenite-martensite transformation produces a substantial level of strain (σ) that is developed over a relatively small range of stress (ε). Upon unloading the stress, the transformation is reversible; however, the stress levels at which the reversible transformation occurs are smaller than the stresses that were require to produce the original austhenite-martensite transformation, as depicted in FIG. 2. Since, upon unloading, the material completely recovers it original shape, it is described as having elastic properties. In nickel titanium alloys, since the transformation strains are so large (greater that 6%) when compared to other alloys (typically on the order 0.1%), the material is defined as superelastic.
The superelastic properties of NiTi, and its strain-induced martensite transformation, can be understood by schematic illustrations of its crystalline lattice structure. The austhentite and martensite phases each define a very distinct crystalline structure or phases, as depicted in FIGS. 3A and 3B. Which phase is present depends on temperature and the amount of stress (consider it as internal pressure) being applied to the material. If a thin-film expanse of nickel titanium alloy is cooled from above its transformation temperature, it will remain 100% austenite until it reaches the martensite start temperature Ms for any particular amount of stress then being applied to the material. As depicted in FIG. 3A the sides of the martensite crystalline lattice marked a, b, and c are all different lengths. When pressure or stress (s) is applied to the lattice, these sides will change in length to compensate for the deformation forces. The angle marked β also can change in response to such deforming forces. When the nickel titanium is elevated in temperature from below its crystallographic phase transition as shown in FIG. 3B, the material will recover its precise "memory" shape above its austenite start (As) temperature which can be designed to be slightly below body temperature (37° C.). In its austenite phase, the nickel titanium has only one possible crystalline orientation, which will be a pre-determined shape of the capsular shaping device. It is because of the wide variability of these lattice parameters that thin-film nickel titanium material can be easily deformed in its martensite phase. This accounts for the "rubbery" superelastic nature of NiTi that allows 6% or more recoverable elastic deformations.
The thin-film NiTi expanse of the invention can be fabricated as described in U.S. Pat. No. 5,061,914 to D. Busch and A. D. Johnson and the following published U.S. patent applications to A. D. Johnson et al.: No. 20020046783 A1 published Apr. 25, 2002; and No. 20010039449 A1 published Nov. 8, 2001. All of the patents and applications referred to in this paragraph are incorporated herein in their entirely by this reference.
The capsular shaping portion of the intracapsular implant corresponding to the invention also can be made in part, or in its entirety, from a class of shape memory polymer (SMP). The term "shape memory" is used in a different context when referring to SMPs. A shape memory polymer is said to demonstrate shape memory phenomena when it has a fixed temporary shape that can revert to a memory shape upon a selected stimulus, such as temperature. A shape memory polymer generally is characterized as defining phases that result from glass transition temperatures in segregated linear block co-polymers: a hard segment and a soft segment. The hard segment of SMP typically is crystalline with a defined melting point, and the soft segment is typically amorphous, with another defined transition temperature. In some embodiments, these characteristics may be reversed together with glass transition temperatures and melting points.
In one embodiment, when the SMP material is elevated in temperature above the melting point or glass transition temperature of the hard segment, the material then can be formed into a memory shape. The selected shape is memorized by cooling the SMP below the melting point or glass transition temperature of the hard segment. When the shaped SMP is cooled below the melting point or glass transition temperature of the soft segment while the shape is deformed, that (temporary) shape is fixed. The original shape is recovered by heating the material above the melting point or glass transition temperature of the soft segment but below the melting point or glass transition temperature of the hard segment. (Other methods for setting temporary and memory shapes are known which are described in the literature below). The recovery of the memory original shape is thus induced by an increase in temperature, and is termed the thermal shape memory effect of the polymer. The temperature can be at or below body temperature (37° C.) or a selected higher temperature.
Besides utilizing the thermal shape memory effect of the polymer, the memorized physical properties of the SMP can be controlled by its change in temperature or stress, particularly in ranges of the melting point or glass transition temperature of the soft segment of the polymer, e.g., the elastic modulus, hardness, flexibility, permeability and index of refraction. The scope of the invention of using SMPs in capsular shaping elements extends to the control of such physical properties, particularly in elastic composite structure described further below.
Examples of polymers that have been utilized in hard and soft segments of SMPs include polyurethanes, polynorborenes, styrene-butadiene co-polymers, cross-linked polyethylenes, cross-linked polycyclooctenes, polyethers, polyacrylates, polyamides, polysiloxanes, polyether amides, polyether esters, and urethane-butadiene co-polymers and others identified in the following patents and publications: U.S. Pat. No. 5,145,935 to Hayashi; U.S. Pat. No. 5,506,300 to Ward et al.; U.S. Pat. No. 5,665,822 to Bitler et al.; and U.S. Pat. No. 6,388,043 to Langer et al. (all of which are incorporated herein by reference); Mather, Strain Recovery in POSS Hybrid Thermoplastics, Polymer 2000, 41(1), 528; Mather et al., Shape Memory and Nanostructure in Poly(Norbonyl-POSS) Copolymers, Polym. Int. 49, 453-57 (2000); Lui et al., Thermomechanical Characterization of a Tailored Series of Shape Memory Polymers, J. App. Med. Plastics, Fall 2002; Gorden, Applications of Shape Memory Polyurethanes, Proceedings of the First International Conference on Shape Memory and Superelastic Technologies, SMST International Committee, pp. 115-19 (1994); Kim, et al., Polyurethanes having shape memory effect, Polymer 37(26):5781-93 (1996); Li et al., Crystallinity and morphology of segmented polyurethanes with different soft-segment length, J. Applied Polymer 62:631-38 (1996); Takahashi et al., Structure and properties of shape-memory polyurethane block copolymers, J. Applied Polymer Science 60:1061-69 (1996); Tobushi H., et al., Thermomechanical properties of shape memory polymers of polyurethane series and their applications, J. Physique IV (Colloque C1) 6:377-84 (1996)) (all of the cited literature incorporated herein by this reference).
The scope of the invention extends to the use of SMP foams for use in elastic composite structures, wherein the capsular shaping element utilizes the polymer foam together with an expanse of nickel titanium alloy. See Watt A. M., et al., Thermomechanical Properties of a Shape Memory Polymer Foam, available from Jet Propulsion Laboratories, 4800 Oak Grove Drive, Pasadena, Calif. 91109 (incorporated herein by reference). SMP foams function in a similar manner as the shape memory polymers described above. The scope of the invention also extends to the use of shape memory polymers that are sometimes called two-way shape memory polymers that can moved between two predetermined memory shapes in response to varied stimuli, as described in U.S. Pat. No. 6,388,043 to Langer et al. (incorporated herein by reference).
Other derivatives of SMPs within the scope of the invention fall into the class of bioerodible shape memory polymers that again may be used in certain elastic composite capsular shaping structures. As will be described below, one embodiment of capsular shaping element may be designed with composite portions that define a first modulus of elasticity for a period of time after implantation to resist force that may be applied by fibrosis during wound healing, followed by a second modulus of elasticity following biodegradation of a surface portion of the elastic composite structure.
In all variants of capsular shaping element that make use of expanses of thin films or composites of shape memory materials, the principal objectives relate to the design of an implant that will impart to the implant/lens capsule complex an unstressed more spherical shape with a lesser equatorial diameter when zonular tension is relaxed, and a stressed flatter shape with a greater equatorial diameter in response to zonular tensioning forces. The superelastic component will provide the ability to absorb known amounts of stress--and release the energy in a predetermined manner in millions of cycles over the lifetime of the implant in cooperation with an optic that will provide variable focus.
Exemplary Biomimetic Intracapsular Devices with Superelastic or Elastic Composite Components
A. Type "A" Implantable Intraocular Devices. FIG. 4 illustrates a cut-away view of an ultrathin flexible, deformable intraocular device (IOD) in the form of a capsular shaping element 100 corresponding to the present invention implanted in a capsular sac or bag 102. FIG. 5 illustrates a hypothetical capsular sac 102 that defines an anterior capsule 104A and a posterior capsule 104B after removal of the crystalline lens matrix LM. This disclosure will adopt the terminology commonly used by ophthalmologists that defines the anterior capsule as the portion of the capsular sac anterior to the capsular equator 108, and the posterior capsule as the sac portion posterior to the equatorial region. In FIG. 5, it can be seen that an anterior engagement plane A and a posterior engagement plane B comprise annular (inner) portions of the anterior and posterior capsules 104A and 104B that are substantially engaged by the capsular shaping element 100 of FIG. 4. The anterior plane A and posterior plane B are radially outward of a central optic zone indicated at C that ranges from about 4.5 to 7.0 mm in diameter. The anterior and posterior planes A and B are radially inward of an equatorial region indicated at E. In this disclosure, the term axis and its reference numeral 115 are applied to both the natural lens capsule and the capsular shaping element 100, and the term axis generally describes the optical axis of the vision system. The axial dimension AD refers to the dimension of the capsular implant or implant/lens capsule complex along axis 115.
In FIG. 4, the capsular shaping element 100 comprises a thin-film expanse 120 of a shape memory material, in this case a nickel titanium alloy, that is encased in a thin layer or coating of a biocompatible polymer 122. FIG. 4 thus shows the capsular shaping element 100 in a perspective view as it would appear in an unstressed state--similar to its appearance prior to its implantation--and maintaining the lens capsule in an open more spherical shape. The combination of the capsular shaping element 100 and the natural lens capsule, defined herein as the implant/lens capsule complex, is adapted to provide a biomimetic lens capsule that can cooperate with the eye's natural accommodation mechanisms to enable a new class of accommodating lens systems that mimic a naturally accommodative human lens capsule.
The IOD 100 of FIG. 4 defines a first anterior surface portion 105A that is adapted to engage the anterior plane A of the anterior capsule 104A of FIG. 5. The capsular shaping element 100 further defines a second posterior surface portion 105B that is adapted to engage the posterior plane B of the posterior capsule 104B of FIG. 5. The capsular shaping element 100 of FIG. 4 illustrates a device that has a discrete number of spaced apart peripheral arcuate extending body portions 112a-112n (where n indicates an integer) that are formed to extend from the anterior plane A of anterior capsule 104A to posterior plane B of posterior capsule 104B in a meridonal manner relative to axis 115. In FIG. 4, the peripheral extending portions 112a-112n transition to an anterior annular body portion indicated at 124a. As will be described in another embodiment below, the annular body portion 124a can be positioned anteriorly or posteriorly in the capsular sac. In the embodiment of FIG. 4, the posterior surface portion 105B comprises a plurality of regions of each arcuate peripheral body portion 112a-112n. It should be appreciated that the number of spaced apart arcuate peripheral portions 112a-112n can range from about 2 to 20, and moreover the wall portion 127 of the capsular shaping element 100 further can extend about the entire circumference of the IOD so that there would not be a plurality of discrete elements, particularly when an elastic composite is used as will be described below.
FIG. 6 shows an alternative embodiment wherein the capsular shaping structure 100 has other optional features and characteristics. First, the thin-film shape memory expanse 120 is insert-molded with a foldable posterior annular polymer portion 124b to thereby provide a broader posterior surface portion 105B to engage plane B of the capsular sac. Further, the intracapsular implant defines an at least partly annular abrupt edge portion 126 (collectively) or projecting ridge for engaging the capsule interior to limit cell migration within the interface between the lens capsule and the implant. Preferably, such an annular edge 126 is provided both on the anterior and posterior surfaces of the implant 100. Third, the thin film shape-memory expanse 120 is shown with micro-machined fenestrations 128 which can be utilized to control localized stress-bearing capacities of the shape memory material. Both shaping elements 100 of FIGS. 4 and 6 can be rolled for introduction into the patient's eye.
Of particular interest, the capsular shaping element 100 of FIGS. 4 and 6 carries a thin film shape-memory alloy form 120 having a thickness of between about 5 microns and 50 microns. More preferably, the single layer of SMA 120 has a thickness between about 10 microns and 40 microns. The nickel titanium alloy form also is fabricated to define an Af (austhenite finish temperature) at less than about 37° C. To provide the thin film with the selected Af, the element is composed of between 45-55% each of titanium and nickel. As described above, the capsular shaping element 100 then will function is it superelastic condition to cooperate with the force of contraction of the human ciliary muscle and zonular tensioning (about 1 to 3 grams of force) about the equator of the capsular sac. In other words, the contracting forces of the ciliary muscle will be sufficient to deform the intraocular device 100 to provide the lens capsule complex with a lesser axial dimension--i.e., a flatter shape. Upon relaxation of the ciliary muscle and zonular tensioning about the equator of the capsular sac, the intraocular device 100 defines recoverable strain properties that returns the element to a less stressed state wherein the intraocular device has a greater axial dimension--i.e., a more spherical or globular shape.
The capsular shaping element 100 of FIGS. 4 and 6 corresponding to the invention also can be defined by its selected dimensions and its 3-D shape for engaging and supporting the interior of the capsular sac. The outer envelope dimensions of an accommodative lens capsule are about 3.0 to 5.5 mm. about the optical axis, with a diameter ranging from about 8.0 to 10.0 mm. Thus, the outer envelope of the capsular shaping element 100 as defined by its planform and molded memory shape (its unstressed state) would match the three dimensional shape of a young still-accommodative lens capsule. The thin-film SMA form together with the capsular sac (i.e., the implant/capsule complex) defines an axial dimension AD greater than about 3 mm. when not subject to zonular tensioning forces. Further, the thin-film expanse that comprises the capsular shaping element 100 has a selected thickness and planform that demonstrates stress/strain recovery at 37° C. in response to zonular tensioning forces that flattens the axial dimension AD to less than 3.0 mm. and preferably lessens the dimension AD by about 1.0 mm. to 2.5 mm. Upon release of zonular tensioning forces, the superelastic thin film expanse 120 will rapidly return the implant/capsule complex to its unstressed state and shape.
The capsular shaping element 100 (FIG. 4) further has a thickness and planform that demonstrates stress/strain recovery at 37° C. in response to zonular tensioning forces that allows stretching of the equatorial diameter of the implant/capsule complex by greater than about 10%. More preferably, the shape memory implant demonstrates stress/strain recovery at 37° C. in response to zonular tensioning forces that allows equatorial stretching by greater than about 15%.
The ciliary muscles CM, choroid and zonular fibers each have a modulus of elasticity, and the capsular shaping element 100 in combination with the capsular sac (i.e., implant/capsule complex) defines a lower modulus of elasticity than any of these tissues to insure they do not unnaturally deform during accommodation. A capsular shaping element 100 that carries a nickel titanium alloy form, in its superelastic state when at body temperature, is the optimal material for deforming in response to zonular tension by absorbing stress and thereafter releasing the absorbed energy to return the complex of the shaping element and lens capsule to its memory shape. In one embodiment corresponding to the invention, the intraocular device carries a seamless thin-film shape memory form that demonstrates a stress/strain recovery greater than 3% at 37° C. More preferably, the thin-film shape memory form demonstrates a stress/strain recovery greater than 5% at 37° C.
FIG. 7 illustrates, for convenience, a single peripheral arcuate body portion 112a of an alternative embodiment of capsular shaping structure 140 and engagement planes A and B. All such peripheral body portions of the shaping element would have a similar shape and function as the single element of FIG. 7. In this variant, the element 140 has an additional "S"curve or bend portion 144 in the shape memory alloy that serves two purposes. First, the additional curve 144 together with the two radially outward curves 145a and 145b can develop greater elastic energy-absorbing and energy-releasing forces than the corresponding element 100 of FIG. 4. The embodiment in FIG. 7 places the superelastic structure more directly between planes A and B. This embodiment 140 provides greater strength that the lesser hoop strength of the device of FIGS. 4 and 6 wherein a single bend portion 145 is provided in the device that urges apart planes A and B.
The second advantage offered by the device 140 of FIG. 7 is that it will substantially engage the lens capsule 102 except for an equatorial band of the capsular sac. As can be seen in FIG. 7, the diameter 146 of the natural lens capsule is shown as it would be engaged and supported by the CSE as in FIG. 4 to provide a substantially elliptical or single radius equatorial region. As can be seen in FIGS. 7, 8A and 8B, the shaping element 140 of FIG. 7 defines a radially outward equatorial envelope that is substantially non-elliptical and without a radius that directly blends into the curvature of the anterior and posterior capsules. Thus, the shaping element 140 of FIG. 7 has a lesser maximum diameter 148 as indicated in FIGS. 8A-8B that will support the capsular sac in a lesser maximum diameter. It is believed that the shaping element 140 will thus support the capsular sac in an optimal open position--but allow the equatorial region of the capsule to shrink controllably after the evacuation of the crystalline lens matrix as occurs in the wound healing response and fibrotic response. This slight shrinkage of the capsular equator will then take any slack out of the zonular ligaments ZL which are believed to become lax due to lens growth over the lifetime of the patient. This will allow for more effective transfer of forces from the ciliary muscle CM to the shaping element 140 via the tightened equatorial region of the capsular sac 102.
FIG. 9 illustrates a portion of an alternative embodiment of capsular shaping device 150 corresponding to the invention that again is adapted to engage planes A and B (see FIG. 5) of a capsular sac 102. This embodiment differs in that the peripheral arcuate portions, or the entire expanse, comprises an elastic composite material (ECM) 152 that carries first and second thin-film NiTi expanses slightly spaced apart and molded into a substantially thick polymer portion indicated at 155. The first SMA form 158a is similar to previous embodiments and the second layer of thin-film nickel titanium alloy is indicated at 158b in FIG. 9. By assembling this composite structure, the implant can provide enhanced load-bearing and response capacities that, for example, may not be attained by a single thin-film NiTi form within an implant body.
FIG. 10 illustrates an exemplary part of an alternative embodiment of capsular shaping element 160 that is similar to previous variants that engage planes A and B (see FIG. 5) of a capsular sac 102. This embodiment differs in that the equatorial portion 162 of the shaping element that flexes in response to stresses applied by the ciliary muscle carries a biodegradable shape memory polymer 165 (or any biodegradable polymer known in the art). A preferred biodegradable polymer is a PHA (polyhydroxyalkanoate), or a co-polymer of a shape memory polymer and a PHA. The purpose of the biodegradable polymer portion 165 is to selectively alter the stress (load) bearing capacity of the equatorial portion 162 of the shaping element over time. It is believed that the initial wound healing response in the capsular sac following removal of the lens matrix will apply shrinkage or fibrotic forces that will lessen after the wound healing response is over. For this reason, the inventive capsular shaping element 160 can have a first greater load-bearing capacity for selected one week to month period after implantation. The capsular shaping element 160 then can define a lesser stress-bearing capacity after the biodegradable polymer 165 has degraded--with the lesser stress-bearing capacity being optimized for cooperating with tensioning forces applied by the ciliary muscle following wound healing.
FIG. 11 illustrates a portion of another alternative embodiment of capsular shaping element 180 that functions generally as the previous variants that engage planes A and B of a capsular sac 102. This embodiment differs in that the equatorial portion 182 of the shaping element that flexes in response to stresses applied by the ciliary muscle during accommodation carries an adjustable shape memory polymer 185. For example, the polymer can be a shape memory polymer that responds to stimuli from an external source to alter its modulus or shape between first and second memory shapes to selectively alter the stress (load) bearing capacity of the equatorial portion 182 of the shaping element at any time following its implantation. As described above, a shape memory polymer can be designed for photothermal modification at a selected level above body temperature to adjust modulus, flexibility, or permeability.
This aspect of the invention is shown in FIG. 11 wherein the external stimulus is light energy (e.g., a wavelength between 380 nm and 1800 nm, not limiting) that can alter the temperature or other parameter of the polymer to change its modulus or shape--which will alter the stress-bearing parameters of the composite. In the embodiment of FIG. 11, the adjustable shape memory polymer 185 is depicted as an exterior layer of the element 180 so that it is more easily exposed to a light beam 188. The light beam can be scanned and with an eye tracking system as is known in the art. The scope of the invention thus includes the use of an external energy source to modify the modulus, flexibility, permeability or other operational parameter of a non-optic portion of an intracapsular implant to optimize its resilient characteristics for enhancing the functionality of an accommodating lens system. It is believed that post-implant adjustability of such parameters will be critical for optimization of such accommodating lens systems. The modifiable polymer can be located in an region of the ophthalmic implant. The scope of the invention includes any form of stimulus, such as energy from a light source, electrical source or magnetic source.
FIG. 12 illustrates another embodiment of capsular shaping element 200 that is similar to the implant of FIG. 4. This version differs in that the polymer portion is shown as extending substantially in a complete expanse 210 that conforms to the inner surface of the capsular sac. Preferably, the expanse 210 is of a transparent material, and in one embodiment is any biocompatible urethane, silicon-urethane copolymer or another shape memory polymer described above. In this embodiment, the thin-film nickel titanium alloy 220 is insert molded into the polymer body portion to provide the stress-bearing capacity of the shaping element.
In all of the above described embodiments, the capsular shaping element and the remaining capsule sac is adapted to mimic a natural lens capsule in balancing its energy-absorbing and energy-releasing characteristics with the forces applied by the ciliary muscle. The capsular shaping element will thus prevent atrophy of the ciliary muscle and allow it to cooperate with, and adjust, the next optional component of the invention which is a cooperating independent IOL or an integrated optic element.
Still, it should be appreciated that the capsular shaping devices of FIGS. 4 to 11 comprise an important ophthalmic implant innovation. The capsular shaping devices will maintain the capsule as an open and viable structure, thus allowing the ophthalmologist to insert and replace any IOL as required to adjust the lens power over the lifetime of the patient. Explanting an in-the-sac IOL is not simple with current IOLs since the designs are intended to be shrink-wrapped in the capsule to maintain lens centration. In the future, it is likely that ultra-thin SMA haptics with thin optics will allow the development of replaceable IOLs that can be inserted and removed with a sub-1.0 mm. entry through the cornea making the IOL exchange an atraumatic procedure. It is believed that IOL replaceability will become a needed refractive option in clear lensectomy procedures to treat presbyopia, wherein over the lifetime of the patient a refractive lens change may be required due to refractive drift, or lens exchange for a new lens technology may be desired (e.g., for a wavefront corrected lens).
B. Type "B" Implantable Intraocular Devices. The Type "B" intraocular devices generally combine any of the Type "A" capsular shaping structures of the invention with an integrated optic portion to thereby provide an integrated accommodating IOL system. FIGS. 13A-13B and 14 illustrate a various views of a capsular shaping body 400 with shape memory alloy form 120 therein similar to that of FIG. 4 with an integrated optic element 410 coupled to the shaping element 400 by haptic portion 412. The haptic portions 412 (i) can be fixedly coupled to body 400, (ii) can be adapted to resiliently press outwardly to self-locate about the equator of the body 400, or (iii) can be adapted to cooperate with an engagement element in body 400 as shown in FIG. 19. FIGS. 13A-13B illustrate how changes in the shape of the CSE portion 400 are captured to cause the optic element 410 translate anteriorly lens to provide additional focusing power. Thus, the IOL system of FIG. 14 provides a substantially true accommodating lens system based on the mechanism of lens translation. In use, psuedo-accommodative vitreous displacement also would be enhanced by the implant that presents a substantially large convex body surface toward the vitreous, which would be an improvement over the reduced surface area of a shrink-wrapped posterior capsule. In this embodiment, the haptic portion 412 again is a superelastic NiTi form encased in a polymer that is further molded to transition to a central foldable lens as in known in the art.
FIGS. 15A-15B illustrate views of an alternative embodiment of integrated IOL 500A with a capsular shaping element portion 505 having NiTi form 120 therein together with an integrated optic portion 510 coupled to the shaping element 505 by an intermediate fixed coupling portion indicated at 502. In this embodiment, the optic portion 510 is a flexible fluid-filled optic with an anterior deformable surface layer 504A and an optional posterior deformable surface layer 504B that contains a displaceable fluid or gel media M therebetween. In such an adaptive optic embodiment, each surface 504A and 504B can comprise a lens element with the displaceable media having any index, or the surfaces 504A and 504B can contain an index-matched displaceable media M therebetween to effectively function as a single optic element. As can be seen in FIGS. 15A-15B, the change in shape of the capsular shaping portion 505 will alter the curvature of a deformable lens surface, or both surfaces, ac and pc to ac' and pc' while translating the optic anteriorly and increasing the thickness of the lens--all of which mimic a naturally accommodating lens to provide lens accommodation. FIG. 15C shows an alternative integrated IOL system 500B wherein the peripheral capsular shaping body 505 is as described previously with a SMA form therein to provide the capsular sac with the desired strain-absorbing properties. In this embodiment, the central optic portion 510 again is a flexible fluid-filled optic but with foldable (but non-adaptive) anterior and posterior lens elements 540a and 540b that contain a displaceable fluid or gel media M therebetween, either index matched or non-index matched. In the embodiment of FIG. 15C, the anterior and posterior lens elements 540a and 540b move apart during accommodation to increase lens power. In essence, this system emulates a natural lens capsule.
FIGS. 16A-16B are views of a Type "B" implant device 500C that has a capsular shaping body portion 505 together with a refined microfluidic system for causing fluid flows into a deformable adaptive optic portion 510 from a peripheral non-optic portion 512 that is adapted to engage the capsular sac. As can be seen in FIG. 16B, the capsular shaping body 505 has a plurality of peripheral arcuate extending elements 516a-516d that can number from about 3 to 12. Alternatively, the body portion 505 can extend 360° about the implant, or a plurality of elements with an intermediate thin sheath element can extend 360° about the implant. The implant defines an open anterior central region.
In the implant 500C of FIGS. 16A-16B, the peripheral capsular shaping portion 512 carries several features that can assist in causing a lens element or elements provide accommodative effects. The peripheral body portion 512 transitions to an annular body portion 526 that carries a posterior lens 520 with a deformable anterior surface 525 that can be controllably deformed by the flow of an index-matched fluid media M to and from an interior space or chamber indicated at 522B. The lens is deformed by flow from at least one peripheral chamber 522A in the peripheral elements 516a-516d. The fluid flows are designed to occur when elements 516a-516d are deformed from their memory shape (FIGS. 16A and 20A) to a temporary shape (FIG. 20B) by zonular tensioning. The memory shape of the body 505 again is provided by a superelastic NiTi form embedded therein (not shown). The peripheral body portion 512, as in all earlier embodiments, is adapted to deform under about 1.0 to 3.0 grams of applied force about the equatorial region of the implant.
In one embodiment as depicted in FIG. 16A, the lens 520 has a negative power and is adapted to cooperate with an independent positive power lens that is implanted in the open central portion of the capsular shaping body 505 as shown in phantom view in FIG. 19. It should be appreciated that the system of the invention can be designed for fluid flows to or from the central optic to add or subtract power to a positive power lens, a negative power lens or a piano lens.
FIG. 17 is a view of the intraocular device of FIGS. 16A-16B showing a method of rolling the device for introduction into the eye, wherein the body 505 is an assembly of a superelastic SMA form insert molded into a shape memory polymer, and the SMP then is compacted to a temporary shape. In such a preferred embodiment, a thin film NiTi form or a NiTi wire form together with the polymer component would be very thin. The peripheral body portion would be in the range of 25 to 100 microns in thickness, which is suitable for rolling or folding as shown in FIG. 17.
FIG. 18 is an exploded view of a manner of fabricating the implant 500C of FIGS. 16A-16B showing two components 532a and 532b de-mated with molded-in flow channels 540 that would communicate between the interior chambers of the optic portion and peripheral non-optic portion. In this embodiment, the deformable lens layer 525 is substantially thin while base portion 524 of the lens is less deformable or preferably non-deformable. The superelastic SMA form 120 (see FIG. 4) is molded into either or both polymer components 532a and 532b. A fluid media M is inserted into the chambers during or after bonding together the polymer components 532a and 532b.
FIG. 19 is a sectional view of an intraocular device 500C similar to that of FIG. 16A showing that the body 505 carries an engagement structure indicated at 560 for cooperating with and positioning the engagement ends 564 of haptics 565 that carries lens 580 (phantom view). FIG. 19 further shows how the optic 580 would translate to provide an accommodative effect as in the previous embodiment of FIGS. 13A-13B and 14.
Now turning to FIGS. 20A-20B, the movement of the peripheral capsular shaping body 512 from its memory shape to a temporary shape will cause compression of wall portion 528a against wall portion 528b to displace fluid media M from interior chambers 522A (collectively) to the interior space 522B in the lens 520 to alter it curvature to AC' from AC. The scope of the invention includes any of a variety of mechanisms and cavity shapes in the non-optic portion 512 that are compressed to cause fluid media flow to the optic portion. Also, the scope of the invention includes mechanisms and cavity shapes in the non-optic portion 512 that are expanded to cause fluid media flow from the optic portion. The interior space in the lens can be (i) centrally located or (ii) peripherally located in an annular region to thereby allow the deformation of the surface to add or subtract power in a plano lens, positive power lens or negative power lens. The peripheral extending portions 516a-516d carry NiTi forms either of a thin film expanse or wire forms to induce the portions 516a-516d toward the memory shape as well as return the chambers 522A to a "memory" volume. The sectional view of FIG. 16A illustrates the capsular sac and implant at, or urged toward, its memory shape as when implanted in a lens capsule LC (reference letter LC indicating the interior of the lens capsule). It can be seen that a substantial volume (first volume) of fluid media M is within the peripheral non-optic portion and chambers 522A therein. In this untensioned or memory state, there is a limited volume of media M in the interior space 522B of the lens.
In a disaccommodative state, referring to FIG. 20B, the sectional view shows the body portion 512 in a tensioned collapsed (temporary) shape when zonular tension flattens the lens capsule and collapses the axial dimension of the implant along optical axis 515. It can be seen that the axial collapse of implant causes compression of the peripheral chambers 522A and moves a volume of fluid media M into space 522B of the lens 520. The increased fluid pressure in the space 522B thereby deforms the lens surface 525 and subtracts from the negative power of the lens. It can be easily understood how this added fluid pressure can be used to reshape a lens to make a deformable surface, whether (i) to make the curvature steeper or flatter with a central interior space 522B or an annular interior space 522B; (ii) to add power or subtract power; or (iii) to move a piano element away from non-refractive parameters toward either a positive or negative power. It is important to note that the method of the invention includes providing a large fluid volume in the peripheral chambers 522A when compared to the lens chamber 522B to thereby provide hydraulic amplification means for transducing and amplifying the mechanical flexing of the body portion 512 to maximize lens deformation. FIG. 21 is a sectional view of an alternative adaptive optic device 500D wherein flexure of the peripheral portion 512 to a flatter shape impinges on the volume of the peripheral chamber portions 522A to subtract from the power of a bi-convex lens by adding an index-matched fluid media to the chamber portion 522B within the lens 520. It can be seen that the deformable surface 525 is restrained at the annular optic periphery by webs 580 to control the shape change in response to fluid media flow.
In any design of capsular shaping body or for an accommodating lens system, it may be necessary to provide post-fabrication adjustment means for (i) adjusting the flexibility and response to the peripheral body's deformation after implantation, (ii) the exact shape of a dimension of the implant to engage the lens capsule, (iii) the amplitude of accommodation, as well as (iv) providing for adjustment of lens optic parameters. To provide for such adjustments, FIG. 22 shows a cut-away view of a capsular shaping body and lens similar to the embodiment of FIG. 16A. A plurality of regions 588 of the capsular shaping body are of a shape memory polymer that is disposed adjacent to an interior space or chamber in the implant. Each SMP portion is responsive to an external energy source that cause it to swell to thereby impinge on the chamber to reduce its volume (increase internal fluid pressure). While the regions are discrete and spaced apart in FIG. 22, they also may be annular or comprise a thin layer of a polymer expanse. Similarly, the SMP regions (not shown) may extend within broad surface regions of the capsular shaping body to alter its modulus or flex characteristics. In particular, altering the mechanical properties of the polymer body component can offset and cooperate with the properties of the NiTi form 120 therein to alter the resilient characteristics of the composite.
FIGS. 23-24 illustrate a capsular shaping system with a first shaping body 500C similar to that of FIG. 16A together with a second independent inverted shaping device 600. The first device is adapted to engage the posterior capsule and a limited equatorial region (cf. FIG. 16A). The second device 600 is adapted for engaging only the anterior capsule and a limited equatorial region. The second shaping device 600 has a number of extending portions 616a-616d that cooperate with and are spaced between the corresponding portions of the first device 500B when implanted in a capsular sac. The second device 600 further defines an annular portion 605 that transitions into the extending portions 616a-616d. Of particular interest, the use of first and second independent shaping devices for engaging the anterior and posterior capsules with independently responsive elements allows the lens capsule to respond to zonular tensioning and de-tensioning more like a natural lens capsule. This can be understood by reference to equatorial indicator markings on the implants in FIGS. 23 and 24 which show the device in accommodative and non-accommodative shapes, respectively. It can be seen that the axial dimension of the capsular complex moves from AD to AD' as the system moves toward a disaccommodative shape (FIG. 24). It can easily be understood (see arrows) that movement of the capsule complex toward its non-accommodative equatorial dimension will cause the extending portions 516a-516d and extending portions 616a-616d to adjust or slip relative to the equatorial plane of the complex. In FIGS. 23 and 24, equatorial indicator markings X and Y on the respective extending portions 516a-516d and extending portions 616a-616d are shown in different alignments with one another when the lens capsule adjusts between accommodative and non-accommodative shapes. Of particular interest, the independent cooperating capsular shaping bodies will prevent the implant from simply forming a hinge at the equatorial apex of the device. By utilizing such a design feature, a greater amplitude of capsular shape change can be achieved for a given amplitude of zonular tensioning. It should be appreciated that the independent devices 500B and 600 can be coupled by thin flexible membranes (not shown) and fall within the scope of the invention, wherein the posterior and anterior shaping bodies still substantially provide the desirable functionality described above to prevent the hinge effect at the equatorial apex of the device.
The previous embodiments have illustrated peripheral body portions that are substantially thin and provided with an elastic response due to the superelastic SMA form 120 insert-molded therein. Embodiments of adaptive optic lens systems as described above are possible without, or with less reliance on, a superelastic shape memory alloy form in the implant. In order to provide a polymer peripheral body portion with suitable resilient characteristics for shaping the capsular sac and responding to zonular tensioning forces, a resilient gel-like shape memory polymer 745 can be used to define a memory shape that occupies a substantial peripheral portion of the capsular sac as in implant 700A of FIG. 25. Still, the shape memory polymer can be compacted to a temporary shape and rolled or folded as in FIG. 17. The fluid media M within the peripheral chamber(s) 722A and optic chamber 722B is non-compressible and accounts for the bulk of the implant that is introduced by an injector through the cornea into the capsular sac. FIG. 25 illustrates an implant device 700A that has a posterior lens that is adaptive in power by exchange of fluid media M between peripheral chamber 722A in peripheral portion 724 and central chamber 722B of lens 720 via channels 740. It can easily be seen from FIG. 25 that fluid can be selectively displaced from the periphery to the center when the respective volumes of the peripheral and central chamber portions are altered upon zonular tensioning and de-tensioning. The embodiment of FIG. 25 operates as the device of FIGS. 16A-16B with induced fluid flows adapted to deform the surface 725 of the adaptive lens 720.
FIGS. 26, 27 and 28 illustrate similar embodiments 700B, 700C and 700D that have peripheral chamber(s) 722A in various locations within the peripheral body for different strategies in collapsing the interior chamber(s) 722A therein to enable the adaptive optic. It can be understood that the interior chambers can be annular or spaced apart, or any combination thereof and be located in various portions of the implant periphery. The peripheral chambers can be in equatorial, posterior or anterior portions of the body periphery to alter the power of a single lens or two spaced apart lenses. The fluid flow channels to the lens are not shown for convenience.
Those skilled in the art will appreciate that the exemplary systems, combinations and descriptions are merely illustrative of the invention as a whole, and that variations in the dimensions and compositions of invention fall within the spirit and scope of the invention. Specific characteristics and features of the invention and its method are described in relation to some figures and not in others, and this is for convenience only. While the principles of the invention have been made clear in the exemplary descriptions and combinations, it will be obvious to those skilled in the art that modifications may be utilized in the practice of the invention, and otherwise, which are particularly adapted to specific environments and operative requirements without departing from the principles of the invention. The appended claims are intended to cover and embrace any and all such modifications, with the limits only of the true purview, spirit and scope of the invention.
Patent applications by John H. Shadduck, Tiburon, CA US