Multi-piece accommodating intraocular lens

Abstract

To provide an accommodating intraocular lens of a plurality of pieces.SOLUTION: An accommodating intraocular lens (AIOL) to be implanted in a crystalline capsule of a patient's eye comprises first and second components coupled together to define an inner fluid chamber and an outer fluid reservoir. An inner region of the AIOL provides optical power with one or more of fluid shaped within the inner fluid chamber and a shape of the first or second components. A fluid reservoir comprises a bellows region with a fold extending circumferentially around an optical axis of the eye. The bellows engages with the crystalline capsule, and a compatible fold region between inner and outer bellows portions allows a profile of the AIOL to deflect when the eye accommodates for near vision. Fluid transfers between the inner fluid chamber and the outer fluid reservoir to provide optical power change. A third lens component coupled to the first or second component provides additional optical power.SELECTED DRAWING: Figure 48

Description

[Technical field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application is a joint venture of U.S. Provisional Application No. 62 / 257,087, filed on November 18, 2015, entitled "MULTI-PIECE ACCOMMODATING IOL" [Attorney Docket No. 120974-8003US00], U.S. Provisional Application No. 62 / 300,695, filed on February 26, 2016, entitled "MULTI-PIECE ACCOMMODATING IOL" [Attorney Docket No. 120974-8004US00], U.S. Provisional Application No. 62 / 331,407, filed on May 3, 2016, entitled "AIOL DELIVERY DEVICE" [Attorney Docket No. 120974-8006US00], and U.S. Provisional Application No. 62 / 331,946, filed on May 4, 2016, entitled "MULTI-PIECE ACCOMMODATING IOL" [Attorney Docket No. 120974-8007US00]. No. 120974-8007US00], U.S. Provisional Application No. 62 / 334,998, filed May 11, 2016, entitled "AIOL DELIVERY DEVICE" [Attorney Docket No. 120974-8008US00], U.S. Provisional Application No. 62 / 344,691, filed June 2, 2016, entitled "MULTI-PIECE ACCOMMODATING IOL" [Attorney Docket No. 120974-8010US00], and U.S. Provisional Application No. 62 / 362,896, filed July 15, 2016, entitled "MULTI-PIECE ACCOMMODATING IOL" [Attorney Docket No. 120974-8011US00], the entire contents of which are incorporated herein by reference.

[0002] TECHNICAL FIELD The present disclosure relates to medical devices and methods. In particular, the present disclosure relates to accommodating intraocular lenses (hereinafter "AIOLs"). [Background technology]

[0003] Cataracts affect a large portion of the world's adult population, causing the natural lens to become clouded and resulting in loss of vision. Patients with cataracts can be treated by removing the natural lens and surgically implanting an artificial intraocular lens (IOL).

[0004] Millions of IOL implantation procedures are performed annually worldwide. In the United States, 3.5 million cataract procedures are performed, while more than 20 million procedures are performed annually worldwide.

[0005] Although IOL implantation can be effective in restoring vision, conventional IOLs, at least in some cases, provide less than ideal results. Many conventional IOLs cannot change focus (known as accommodation) like the natural crystalline lens. Also, an eye receiving a conventional IOL may have at least some refractive error after implantation, so glasses may be useful for distance vision. Conventional IOLs may be effective in providing good distance vision, but in many cases patients will need to wear glasses for intermediate and near vision. Conventional multifocal IOLs have been proposed to address this shortcoming, but conventional multifocal IOLs may be less than ideal. Multifocal IOLs generally work well for reading and distance vision, at least in some cases, but conventional multifocal IOLs may produce significant glare, halos, and visual artifacts, at least in some cases.

[0006] Although accommodating IOLs (AIOLs) have been proposed to provide accommodative optical power depending on the distance at which a patient views an object, conventional AIOLs may be less than ideal in at least some respects. For example, conventional AIOLs may provide a less than ideal amount of accommodation after implantation and may provide a less than ideal refractive correction of the eye. Also, the amount of accommodation of conventional AIOLs may be reduced after implantation, at least in some cases. At least some conventional AIOLs may be somewhat larger than ideal when inserted through an incision in the eye and may require a somewhat larger incision than ideal. Also, studies related to the embodiments suggest that at least some conventional AIOLs may be less stable than ideal when placed on the eye, at least in some cases.

[0007] It would be desirable to have an improved implantable intraocular lens that accommodates with the eye's natural accommodative response that overcomes at least some of the above-mentioned shortcomings. Ideally, such an improved AIOL, when implanted, would provide increased accommodation, provide refractive stability, introduce little, if any, perceptible visual disturbance, and allow the eye's optical power to change from distance to near vision depending on the distance of the object the patient is viewing. Summary of the Invention [Means for solving the problem]

[0008] The embodiments of the present disclosure provide improved AIOL methods and devices. In many embodiments, the AIOL comprises an internal fluid reservoir and an external fluid reservoir disposed in series around the internal fluid reservoir. The internal region of the AIOL includes the internal fluid reservoir and provides optical power. The external fluid reservoir may include a bellows region fluidly coupled to the lens capsule. The AIOL provides accommodation of optical power in one or more ways. Complaint fold regions of the bellows region can allow a profile of the internal region of the AIOL to deflect when the eye accommodates to near vision. The bellows region allows fluid to move between the internal fluid chamber and the external fluid reservoir to provide optical power change as the eye accommodates. At the outer edge of the internal fluid chamber, a plurality of protrusions, such as posts or protrusions, can provide a predetermined amount of separation between the first and second lens components and can define one or more fluid channels between the internal fluid chamber and the external fluid reservoir. The bellows can be configured in many ways, but in many embodiments the bellows extends continuously and circumferentially about the optical axis of the lens, with one or more folds on opposite sides of the bellows extending toward each other in a similar direction as the optical axis. The folds of the bellows can extend substantially continuously and circumferentially about the optical axis, for example extending 360 degrees about the optical axis.

[0009] An aspect of the present disclosure provides an accommodating intraocular lens for placement in a subject's capsular bag. The accommodating intraocular lens may include a first component having a first lens region and a first bellows region, and a second component having a second lens region and a second bellows region, the second component being coupled to the first component. A fluid chamber may be formed between the first lens region and the second lens region. A fluid reservoir may be formed between the first bellows region and the second bellows region, where the fluid reservoir is in fluid communication with the fluid chamber to move fluid between the fluid chamber and the fluid reservoir in response to a shape change of the capsular bag, providing an optical power change to the accommodating intraocular lens.

[0010] In many embodiments, the first lens component is bonded to the second lens component at an interface. The protrusion can be located on an inner surface of one or more of the first or second lens components to provide a gap between the first and second components. The first lens component can be bonded to the second lens component at an interface that extends circumferentially around the first and second lens components.

[0011] The first bellows region can extend continuously circumferentially around the first lens region, and the second bellows region can extend continuously circumferentially around the second lens region.

[0012] The first bellows region may include one or more folds that extend continuously circumferentially around the optical axis of the first lens region, and the second bellows region may include one or more folds that extend continuously circumferentially around the optical axis of the second lens region.

[0013] The first bellows region may include a first one or more folds extending inwardly and circumferentially continuously around the first lens region, and the second bellows region may include a second one or more folds extending inwardly and circumferentially continuously around the second lens region, the first one or more folds and the second one or more folds extending toward each other.

[0014] The first component may include a first annular shaped rigid coupling structure extending circumferentially between the first lens region and the first bellows region to inhibit radial movement of the first lens region with radial movement of the first bellows region. The second component may include a second annular shaped rigid coupling structure extending circumferentially between the second lens region and the second bellows region to inhibit radial movement of the second lens region with radial movement of the second bellows region. The first annular shaped structure may include a first radial thickness greater than a first thickness of the first bellows region, and the second annular shaped structure may include a second radial thickness greater than a second thickness of the second bellows region.

[0015] The first lens region may comprise an anterior lens region and the second lens region may comprise a posterior lens component. The first lens region may comprise a first planar member and the second lens region may comprise a second planar member. One or more of the first or second components may comprise a shell, such as a non-planar shell. One of the first or second components may comprise a planar member and the other of the first or second components may comprise a plano-convex member shaped to provide an optical power.

[0016] The fluid in the fluid chamber may shape the fluid chamber to provide the optical power. The optical power change of the accommodating intraocular lens may include a change in optical power provided by the shape of the fluid in the fluid chamber. The optical power change provided by the shape of the fluid in the fluid chamber may include a change in the shape of the fluid chamber. The optical power change of the accommodating intraocular lens may include a change in the separation distance between the first lens region and the second lens region.

[0017] The protrusions at the outer edges of the edges of the first and second lens regions and radially inward from the bellows region may overlap and be bonded to one another.

[0018] The fluid reservoir may include a compliant fold region between the inner and outer bellows. The compliant region may be thinner than the inner and outer bellows. The lens chamber may be deflectable in response to deflection of the compliant fold region of the fluid reservoir. The compliant region may be thinner than the inner and outer bellows portions located radially inward and radially outward, respectively, relative to the fold region.

[0019] The accommodating intraocular lens may further include a plurality of protrusions, such as one or more of a protrusion and a post, coupled to one or more of the first and second lens components, which may be separated from one another. The plurality of protrusions may be disposed along an outer edge of the inner portion of the first and second lens components. The plurality of protrusions may define a plurality of fluid channels between the fluid chamber and the fluid reservoir, each fluid channel may be defined between two adjacent protrusions, such as posts or protrusions.

[0020] The protrusion can be located between the bellows region and the lens region and connect the first lens component to the second lens component. The protrusion can be located on one or more rigid coupling structures of one or more of the first lens component or the second lens component and provide a gap between the first component and the second component, and can define a plurality of channels extending around the protrusion and between the chamber and the reservoir to fluidly connect the reservoir to the chamber.

[0021] In many embodiments, the fluid reservoir comprises a conformable fold region between the inner bellows region and the outer bellows region, the conformable region being thinner than the inner and outer bellows.

[0022] In many embodiments, the plurality of protrusions are coupled to the first or second component and separate the first and second lens components from one another. The plurality of protrusions can be disposed between the bellows region and the lens region, and the plurality of protrusions can define a plurality of fluid channels between the fluid chamber and the fluid reservoir, each of the plurality of fluid channels being defined between two adjacent struts.

[0023] One or more of the first or second lens components may include a polymeric material, such as a PMMA copolymer. The polymeric material may be water permeable. The polymeric material may be hydrophilic. Water within the subject's capsule may move through the polymeric material into or out of one or more of the fluid chambers or fluid reservoirs to achieve osmotic equilibrium when the accommodating intraocular lens is placed in the capsule. The polymeric material may be impermeable to compounds having a molecular weight of greater than 40 kDa, for example. The accommodating intraocular lens may further include a fluid in the fluid chamber. The fluid may comprise one or more of a solution, an oil, a silicone oil, a solution of dextran, a solution of high molecular weight dextran, or a solution of another high molecular weight compound.

[0024] In many embodiments, the fluid reservoir comprises a continuous baffle structure disposed around the periphery of the fluid chamber. The continuous structure may comprise one or more of a circular, elliptical, or rotationally symmetric shape.

[0025] In many embodiments, the first and second components are sufficiently flexible to be folded into a reduced cross-section delivery configuration. The reduced cross-section delivery configuration comprises one or more folds or rolls of the intraocular lens about a delivery axis that is transverse to the optical axis of the accommodating intraocular lens. The accommodating intraocular lens may comprise a delivery tube or aperture, and the reduced cross-section delivery configuration comprises the intraocular lens advanced into the delivery tube or aperture.

[0026] In many embodiments, the fluid reservoir comprises a haptic structure that engages the capsular bag.

[0027] In many embodiments, the fluid in the fluid chamber has a refractive index greater than the refractive index of the aqueous humor of the eye, which is about 1.336.

[0028] In many embodiments, the first or second lens regions provide no optical power.

[0029] In many embodiments, the fluid in the fluid chamber provides the optical power.

[0030] In many embodiments, the first and second lens components are bonded to one another.

[0031] In many embodiments, the first and second lens components comprise a polymeric material, and the first and second lens components are combined with a prepolymer of the polymeric material.

[0032] In many embodiments, one or more of the first lens component or the second lens component are directly fabricated, such as by three-dimensional (3D) printing.

[0033] In many embodiments, the first lens component and the second lens component are fabricated directly together and form a single piece.

[0034] In many embodiments, the first lens component and the second lens component are molded separately and bonded together.

[0035] In many embodiments, the first lens component and the second lens component are lathed separately and bonded together.

[0036] In many embodiments, the first lens component and the second lens component are bonded together at a protrusion that extends between the first and second components.

[0037] In many embodiments, the first lens component comprises a first fabricated part and the second lens component comprises a second fabricated part.

[0038] Aspects of the present disclosure provide a method of providing accommodation to a subject's eye. Varying compressive forces from a capsular bag can be received by an external fluid reservoir of an accommodating intraocular lens placed in the capsular bag of the eye. In response to the received varying compressive forces, fluid is forced between an internal fluid chamber of the accommodating intraocular lens and a bellows region of the external fluid reservoir, the bellows region comprising a fold that extends continuously circumferentially around the optical axis of the intraocular lens. One or more of the size or shape of the internal fluid chamber can be changed in response to the fluid forced into or out of the internal fluid chamber to change the optical power of the accommodating intraocular lens.

[0039] In many embodiments, the inner and outer bellows regions are in fluid communication with each other and with the inner fluid chamber. One or more of the bellows regions may be annular, elliptical, or rotationally symmetric in shape.

[0040] In many embodiments, the fluid reservoir comprises a haptic structure that engages the capsular bag.

[0041] In many embodiments, varying one or more of the size or shape of the internal fluid chamber includes varying a separation distance between portions of the first and second lens regions.

[0042] In many embodiments, varying one or more of the size or shape of the internal fluid chamber includes varying a radius of curvature of one or more of the first or second lens regions that define the internal fluid chamber.

[0043] In many embodiments, the accommodating intraocular lens comprises first and second lens regions defining an internal fluid chamber, and one or more of the first or second lens regions comprises a plano-convex member shaped to provide a minimum optical power to the accommodating intraocular lens.

[0044] In many embodiments, the internal fluid chamber has a fluid therein, and the internal fluid chamber shapes the fluid such that the fluid provides optical power to the accommodating intraocular lens.

[0045] In many embodiments, fluid is urged into the internal fluid chamber by increasing a variable compressive force.

[0046] The embodiments of the present disclosure provide improved AIOL methods and devices. In many embodiments, the AIOL comprises an optical structure including a rigid member and a deflectable member coupled to a haptic structure, where the rigid member and the deflectable member substantially define a chamber of the AIOL. The chamber of the AIOL contains a fluid having a refractive index greater than the aqueous humor of the eye, so that the deflectable member defines a convexly curved surface of the chamber fluid to be a fluid lens having an adjustable optical power. The deflectable member and the rigid member may be coupled to the haptic structure to deflect the profile of the deflectable member and the fluid lens to a convexly curved profile when the eye is accommodated to near vision. In many embodiments, when the capsule moves inward to accommodate the eye to near vision, the haptic structure rotates relative to the rigid member to provide an inward force on the deflectable member. The haptic structure may include a curved capsule engagement portion shaped to receive the capsule. The haptic structures may be coupled to the rigid member at a first region and to the deflectable member at a second region between the first region and the capsule-engaging portion such that the force of the capsule can be increased by leverage to provide an increased amount of inward force to the outer portion of the deflectable member. In many embodiments, the deflectable member is configured to amplify the inward movement of the outer portion of the deflectable member such that as the eye accommodates, the inner portion of the deflectable member moves away from the rigid member more than the outer portion of the peripheral portion moves inward. This amplification of the movement of the inner portion of the deflectable member and the corresponding increase in curvature coupled with the leverage of the capsule force of the haptics can result in improved accommodation of the AIOL.

[0047] In many embodiments, the arrangement of the rigid member, deflectable member, and rotating haptics can deflect the deflectable member with an inward force, thereby allowing a reduced amount of fluid to be used in the AIOL and reducing the size of the incision. In many embodiments, the arrangement of the rigid member, deflectable member, and rotating haptics can deflect the deflectable member with an inward force without fluid pressure in the lens chamber, and in at least some embodiments, this arrangement can cause the deflectable member to have a convex curvature due to negative pressure in the chamber. In many embodiments, the chamber defined at least in part by the deflectable member and rigid member receives fluid from an outer portion of the chamber below an outer portion of the deflectable member, thereby reducing the amount of fluid contained in the AIOL and the insertion profile.

[0048] The optical structure may be configured to provide an increased amount of accommodation in one or more of many ways. The deflectable member may include an inner optical correction portion and an outer extension portion, providing a curvature transition between the inner optical portion and the haptics. The oppositely curved outer portion may reduce the diameter of the optical correction portion to concentrate the optical power change within the inner portion. When the eye is accommodated to near vision, the inner portion may include an outer convexly curved surface that provides the optical power by the fluid in the chamber, and the extension may include a concave curvature that is opposite to the curvature of the inner portion. The oppositely curved extension may reduce the size of the inner optical zone, thereby increasing the optical power and curvature provided to the deflectable member. The outer surface of the inner portion of the deflectable member may be convexly curved, concavely curved, or substantially flat for distance vision, and has a more positive curvature when deflected to the accommodation configuration for near vision. The outer surface of the outer portion may be concavely curved, or substantially flat for distance vision, and has a more negative curvature when deflected to the accommodation configuration for near vision. The inner surfaces of the inner and outer portions of the deflectable member may be similarly curved. In many embodiments, the deflectable member has a substantially uniform thickness. Alternatively, the outer portion may have a reduced thickness relative to the inner portion and may have an outer surface with a concave profile that facilitates a convex curvature of the inner portion when an inward force is applied by the haptics. The outer portion may be sized such that when the inner portion has a convex curvature and the outer portion has a concave curvature, at least a portion of the outer portion is covered by the pupil to inhibit aberrations.

[0049] In many embodiments, the rigid member comprises a lens, such as a plano-convex lens, having an optical power configured to treat the patient's distance vision. As the eye accommodates, the deflectable portion provides additional optical power for near vision. In many embodiments, the diameter of the lens of the rigid member is sized smaller than the outer portion of the deflectable member so that the diameter of the lens of the rigid member matches the diameter of the inner portion of the deflectable member, thereby reducing the thickness profile of the AIOL when inserted into the eye.

[0050] In many embodiments, the accommodating IOL comprises a first lens component and a second lens component, each composed of a polymer and an adhesive comprising a polymer. Alternatively, or in combination, the first component may be secured to the second component by a mechanical connection, such as an articulating joint, a screw, a fitting, or a fastener. In many embodiments, the polymer is hydrated and may expand upon hydration, so that the first component, the second component, and the adhesive expand together (e.g., simultaneously or at substantially similar rates). By expanding together, stresses between the first component, the second component, and the adhesive may be substantially inhibited. Also, the hydratable adhesive allows the first and second components to be machined in a rigid, not fully hydrated configuration before bonding the components together. The rigid configuration may include a polymer that is not fully hydrated, such as a substantially dry polymer. The components may be bonded together in a substantially rigid configuration to facilitate handling during manufacturing, and may be substantially hydrated such that the adhesively bonded components have a flexible, hydrated configuration for insertion into the eye. An adhesive including a polymer can bond the first and second lens components together with chemical bonds similar to the polymer material itself to provide increased strength.

[0051] In one aspect, an intraocular lens comprises an optical structure having an optical power and a haptic structure. The optical structure comprises a deflectable member, a rigid member, and a fluid chamber at least partially defined by the rigid member and the deflectable member. The haptic structure has an outer structure that engages the capsule of the eye and an inner structure coupled to the deflectable member, and when the haptic structure rotates relative to the rigid member, it increases the curvature of the deflectable member.

[0052] In many embodiments, the deflectable member is deflected from a first profile to a second profile, the second profile being more curved than the first profile. The chamber comprises a fluid having a refractive index greater than 1.33 such that the chamber has a first amount of optical power when the deflectable member is in the first configuration and a second amount of optical power when the deflectable member is in the second configuration, the second amount of optical power being greater than the first amount.

[0053] In many embodiments, the deflectable structure comprises an inner optic portion and an outer extension portion. To increase the optical power, the rigid member, haptics, and deflectable member may be arranged such that the inner optic portion moves away from the rigid member with an increased curvature and the outer extension moves toward the rigid member with an opposite curvature. The inner optic portion moves away from the rigid member and the outer extension moves toward the rigid member, which may reduce fluid movement and reduce the fluid volume of the AIOL by allowing fluid to be transferred from an outer portion of the chamber below the outer extension portion to an inner portion of the chamber below the inner optic portion.

[0054] In many embodiments, rotation occurs about an axis that extends through the periphery of the haptics. When the intraocular lens is placed in the eye, the periphery of the haptics may, for example, lie in a plane that transverses the optical axis of the eye.

[0055] In many embodiments, the haptic structure may comprise a cantilevered haptic structure secured on an inner end to the rigid member at a first location. The haptic portion may comprise a length extending a distance from the inner end to the outer end. The haptic structure has a thickness, and the length may be greater than the thickness. The deflectable member may be coupled to the haptic structure at a second location separated from the first location by a separation distance. The length may be greater than the separation distance to separate an inner optical portion of the deflectable member from the rigid member when the haptic structure rotates relative to the rigid member.

[0056] In many embodiments, the rigid member comprises one or more convexly curved optical surfaces. The rigid member may extend to a thinned portion located near an outer edge of the rigid member. The thinned portion may define a fixed pivot structure about which the haptics rotate such that as the haptics rotate in response to pressure of an ocular structure, a radial force biases the deflectable member inwardly.

[0057] In many embodiments, the deflectable member comprises an inner optic portion and an outer elastic extension coupled to a haptic structure. The elastic extension may have a thickness less than a thickness of the inner region of the deflectable member. The elastic extension may have a curvature opposite to that of the inner optic portion when the elastic extension separates the inner optic portion of the deflectable member from the rigid member. In response to rotation of the haptic structure relative to the rigid member, an inner edge of the haptic structure may exert a radial force on the elastic extension of the deformable member to urge the inner optic portion away from the rigid member by a spherical deflection of the inner optic portion and urge the extension toward the rigid member, reducing the diameter of the inner optic portion or deflecting the curvature of the elastic extension and the inner optic portion in opposite directions relative to each other.

[0058] In many embodiments, the reduction in diameter of the deflectable member includes transitioning from a first diameter to a second diameter smaller than the first diameter in response to rotation of the haptic structure, the reduction in diameter causing the inner optical portion to spherically deflect away from the rigid member and changing the shape of the fluid-filled chamber to a more convexly curved profile to increase the optical power of the optical structure.

[0059] In many embodiments, the convexly curved profile of the fluid-filled chamber provides an increased volume to change the optical power of the optical structure. Fluid can be drawn into the chamber from a peripheral reservoir in response to the increased volume.

[0060] In many embodiments, the haptic structures may move a peripheral portion of the deflectable member radially inward a first distance in response to a directed radial force, and an interior region of the deformable member may be biased away from the rigid member a second distance greater than the first distance in response to a rotation of the haptic structures to amplify the second movement relative to the first movement and shape the deflectable member having a spherical profile. The deflectable member may have a substantially uniform and consistent thickness to resist distortion.

[0061] In another aspect of the disclosure, a method of providing accommodation to a patient's eye includes placing an intraocular lens in a capsular bag of the eye. The intraocular lens can have an optical structure and a haptic structure coupled to the optical structure at an outer region of the optical structure. The optical power of the optical structure of the intraocular lens can be changed by rotating the haptic structure at the outer region in response to an inward force of the capsular bag.

[0062] In many embodiments, the haptic structures rotate about an axis that extends through the periphery of the haptic structures. When the intraocular lens is placed in the eye, the periphery of the haptic structures may, for example, be in a plane that is transverse to the optical axis of the eye. In many embodiments, the method may further include translating at least a portion of the optical structures forward relative to the outer edge of the haptic structures in response to the rotation of the haptic structures. Translating at least a portion of the optical structures may change the optical power of the eye.

[0063] In many embodiments, at least a portion of the optical structure may comprise a deflectable profile member comprising an exterior region coupled to an inner edge of the haptic structure, an interior region, and a pivot region between the haptic structure and the interior region. The interior edge of the haptic structure may exert an inward force on the exterior region of the deflectable member to one or more of reduce its diameter or pivot the exterior and interior regions relative to one another at the pivot region, deflecting the interior region away from the rigid member in response to the rotation of the haptic structure to change the haptic power. Reducing the diameter of the deflectable member and pivoting the exterior and interior regions of the deflectable member relative to one another may change one or more of the shape or volume of a fluid-filled chamber to change the optical power of the optical structure. The interior edge of the haptic portion may move a first distance relative to the interior edge in response to a radial force directed at the interior edge, and the interior region of the deflectable member may be deflected a second distance greater than the first distance away from the rigid member in response to the rotation of the haptic structure.

[0064] In another aspect of the present disclosure, an intraocular lens is provided. The intraocular lens may include an optical structure having an optical power and including a deflectable member, a rigid member, and a fluid chamber at least partially defined between the deflectable member and the rigid member. The intraocular lens may include a haptic structure coupled to a peripheral region of the rigid member and including a first outer element, a second outer element, and a fluid reservoir at least partially defined between the first outer element and the second outer element. The fluid reservoir may be in fluid communication with the fluid chamber including one or more channels. The haptic structure may be configured to rotate at the peripheral region to change the optical power, and the second outer element may be configured to deflect inward toward the first outer element to reduce the volume of the fluid reservoir in response to an inward force of the lens capsule. In many embodiments, the haptic structure is configured to rotate about an axis extending through the periphery of the haptic structure. When the intraocular lens is placed in the eye, the periphery of the haptic structure may be in a plane that transverses the optical axis of the eye, for example. In many embodiments, the second outer element may have an exterior region, an interior region, and a pivot region between the exterior region and the interior region. The exterior and interior regions of the second outer element may pivot relative to one another at the pivot region, deflecting the second outer element toward the first outer element. In many embodiments, the volume of the fluid chamber may increase in response to a decrease in the volume of the fluid reservoir, changing the optical power. The shape of the fluid-filled chamber may change in response to an increase in the volume of the lens fluid chamber, changing the optical power. The shape change of the fluid-filled chamber may include an interior region of the deflectable member deflecting away from the rigid member and a radius of curvature of the deflectable member decreasing. In many embodiments, the inner edge of the haptic structure may move a first distance in response to a rotation of the haptic structure, and the interior region of the deflectable member may deflect away from the rigid member a second distance greater than the first distance, changing the optical power. The shape change of the fluid chamber may leave the geometry of the rigid member substantially undeflected.

[0065] In many embodiments, the deflectable member may include an outer region coupled to an inner edge of the haptic structure, an inner region, and a pivot region between the outer and inner regions. The inner edge of the haptic structure may exert an inward force on the outer region of the deflectable member, changing its diameter, or pivoting the outer and inner regions relative to each other at the pivot region to deflect the inner region away from the rigid member in response to the rotation of the haptic structure to change the optical power of the optical structure. The deflectable member and the rigid member are supported by the haptic structure and may translate together in a first direction in response to the rotation of the outer end of the haptic structure in a second direction opposite the first direction. The deflectable member may be located at a posterior portion of the optical structure and the rigid member may be located at an anterior portion of the optical structure of the eye. The deflectable member may move posteriorly relative to the rigid member as the haptic structure rotates in response to the inward force of the lens capsule, increasing the curvature of the deflectable member. The tactile structure can cause the rigid member and the deflectable member to translate forward together such that an increase in the curvature of the deflectable member, a deflection of the deflectable member backward relative to the rigid member, and a translation of the rigid member and the deflectable member forward each increase the optical power of the eye.

[0066] This aspect of the disclosure may also provide a method of providing accommodation to a patient's eye, such as by providing an intraocular lens and using the provided intraocular lens.

[0067] In another aspect of the disclosure, a method is provided for providing accommodation to a patient's eye. The method may include placing an intraocular lens in a capsular bag of the eye. A haptic structure of the intraocular lens at a peripheral portion of the optical structure of the intraocular lens may be rotated in response to an inward force of the capsular bag. The rotation may occur around an axis extending through the outer periphery of the haptic structure. The members of the optical structure may be deflected to a more curved profile in response to the rotation, changing the optical power of the eye. The shape and volume of a fluid chamber of the optical structure may change in response to the rotation, changing the optical power. The shape and volume of the fluid chamber may change by deflecting one or more of the anterior or posterior members of the optical structure to increase the radius of curvature. The optical structure may be translated in an anterior direction relative to the outer edge of the haptic structure in response to the rotation, changing the optical power. In many embodiments, a combination of such separation, deflection, and translation may be combined to change the optical power.

[0068] In yet another aspect of the disclosure, a method of providing accommodation to a patient's eye is provided. The method may include placing an intraocular lens in a capsular bag of the eye. The intraocular lens may include an optical structure and a haptic structure coupled to a peripheral region of the optical structure. The optical power of the optical structure of the intraocular lens may be changed by rotating the haptic structure of the intraocular lens at the peripheral region to reduce a volume of a fluid reservoir of the haptic structure in response to an inward force of the capsular bag. The rotation of the haptic structure of the intraocular lens may occur about an axis extending through an outer periphery of the haptic structure. When the intraocular lens is placed in the eye, the outer periphery of the haptic structure may be in a plane that is transverse to the optical axis of the eye, for example. The fluid reservoir of the haptic structure may be at least partially defined between a first and a second outer member of the haptic structure. The volume of the fluid reservoir may be reduced by deflecting the second outer member inward toward the first outer member in response to an inward force. Varying the optical power of the optical structure may further include increasing a volume of a fluid chamber of the optical structure in response to a decrease in the volume of the fluid reservoir. Varying the optical power of the optical structure may further include changing a shape of the fluid-filled chamber in response to an increased volume of the fluid-filled chamber.

[0069] In many embodiments, changing the shape of the fluid-filled chamber includes deflecting an interior region of the deflectable member of the optical structure away from the rigid member and decreasing the radius of curvature of the deflectable member toward the rigid member. The shape of the fluid-filled chamber can be further changed by translating the interior and exterior regions of the deflectable member away from the rigid member. The inner edge of the haptic structure can move a first distance in response to a rotation of the haptic structure. The interior region of the deflectable member can be deflected away from the rigid member a second distance greater than the first distance to change the optical power. The shape change of the fluid-filled chamber can leave the geometry of the rigid member substantially undeformed. When placed on the eye, the deflectable member of the optical structure can be located at a posterior portion of the optical structure and the rigid member can be located at an anterior portion of the optical structure. Changing the optical power of the optical structure may include moving the deflectable member forward relative to the rigid member as the haptic structure rotates in response to the inward force of the capsular bag to increase the curvature of the deflectable member and increase the optical power of the eye. The rigid member and the deflectable member may be translated forward together with the haptic structure to increase the optical power of the eye. The periphery of the deflectable member may be separated away from the periphery of the rigid member to increase the optical power of the eye. In many embodiments, such deflection, translation, and separation may be used in combination to change the optical power of the eye.

[0070] In another aspect of the disclosure, an intraocular lens comprises an optical structure comprising a posterior member, an anterior member, and a fluid-filled chamber between the posterior and anterior members. The intraocular lens includes a haptic structure that occludes peripheral regions of the posterior and anterior members to prevent leakage of fluid into and out of the fluid-filled haptic chamber. In many embodiments, the occluding region may comprise a fluid-tight seal to prevent leakage of fluid. The haptic structure may have a first side having one or more male members and a second side having one or more female members. The one or more male members may pass through the peripheral regions of the posterior and anterior members to be received by the one or more female members to occlude the peripheral regions. The peripheral regions of the posterior and anterior members may have one or more openings through which the one or more members pass. The one or more peripheral regions of the posterior or anterior members may have one or more male members to be received by the one or more female members of the haptic structure to occlude the peripheral regions. Occlusion of the peripheral regions of the posterior and anterior members by the haptic structures can be maintained when the intraocular lens is one or more of deformed to change the optical power of the optical structures or folded or rolled into a delivery configuration.

[0071] In yet another aspect of the present disclosure, an intraocular lens is provided. The intraocular lens comprises an optical structure comprising a posterior member, an anterior member, and a fluid-filled chamber between the posterior and anterior members that provides an optical power. The intraocular lens may comprise a haptic structure coupled to the optical structure. One or more of the shape or volume of the fluid-filled chamber may be configured to change in response to a radial force applied to the haptic structure. The change in one or more of the shape or volume of the fluid-filled chamber may change the optical power of the fluid-filled chamber, while the optical power provided by the posterior and anterior members remains substantially unchanged.

[0072] In another aspect of the disclosure, a method of providing accommodation to a patient's eye is provided. The method may include placing an intraocular lens in a capsular bag of the eye. One or more of the shape or volume of a fluid-filled chamber of the intraocular lens is altered to change the optical power of the fluid-filled chamber while the optical power provided by the posterior and anterior members remains substantially unchanged.

[0073] In yet another aspect of the present disclosure, an intraocular lens is provided. The intraocular lens may include an optical structure for placement in an eye.

[0074] In another aspect of the present disclosure, a method is provided. The method may include placing an optical structure on an eye.

[0075] In many embodiments, the deflectable optical elements described herein have the advantage of deflecting while substantially maintaining the thickness of the optical element, since they resist optical aberrations as the element deflects.

[0076] Aspects of the present disclosure provide an intraocular lens for implantation within a capsular bag of a patient's eye. The intraocular lens may comprise an optical structure and a haptic structure. The optical structure may have a peripheral portion and may comprise a planar member, a plano-convex member coupled to the planar member at the peripheral portion, and a fluidic optical element defined between the planar member and the plano-convex member. The fluidic optical element may comprise a fluid having a refractive index similar to either or both of the materials comprising the planar member and the plano-convex member. The haptic structure may couple the planar member and the plano-convex member at the peripheral portion of the optical structure. The haptic structure may comprise a fluid reservoir in fluid communication with the fluidic optical element and a peripheral structure for connecting to the capsular bag. Changing the shape of the capsular bag can result in one or more of a change in volume or shape of the fluidic optical element corresponding to the deformation of the planar member to modify the optical power of the fluidic optical element. For example, a change in shape of the capsular bag can cause the haptic structure to apply a mechanical force at the planar member to deform the member and correspondingly modify the optical power of the fluidic optical element. Such changes to the planar member may, in some cases, not result in a change in the optical power of the planar member, the plano-convex member, or both (i.e., the change in optical power may be merely due to one or more of a shape or volume change to the fluid optical element, and optionally, a change to the anterior-posterior position of the intraocular lens within the capsular bag).

[0077] The haptic peripheral structure may be rigidly coupled to the substantially planar member of the optical structure such that a radially directed force on the haptic peripheral structure may deflect the substantially planar member away from the plano-convex member to modify the optical power of the fluid optical element. The planar member may be fixed to the structure along a circular peripheral portion of the planar member. Deflection of the planar member away from the plano-convex member may provide a spherical optical correction. The change in optical power of the fluid optical element may include a response to movement of fluid from a fluid reservoir of the haptic structure into or out of the fluid optical element.

[0078] A force applied to the haptic fluid reservoir can deform the haptic fluid reservoir and modify the optical power of the fluidic optical element. A force applied to the haptic fluid reservoir can move fluid from the haptic fluid reservoir into or out of the fluidic optical element, reversibly deforming the haptic fluid reservoir.

[0079] In many embodiments, the change in volume to the fluid optical element is provided by the fluid in the haptic fluid reservoir. In many embodiments, fluid movement into or out of the fluid optical element leaves the plano-convex member undeformed. The plano-convex member may comprise a rigid member and the planar member may comprise a deflectable member. In these embodiments, the fluid optical element may provide a majority of the optical power of the intraocular lens. The fluid in the fluid optical element and in the fluid reservoir of the haptic structure may have a refractive index greater than or equal to 1.33.

[0080] The fluid in the fluid reservoir of the fluidic optical elements and haptic structures may include an oil, such as silicone oil, or a solution, such as high molecular weight dextran. The fluid may be provided with a suitable refractive index. The high molecular weight dextran is configured with a suitable refractive index of greater than 1.33 and an osmotic pressure similar to the aqueous humor of the eye. The high molecular weight dextran may have an average molecular weight of at least 40 kDa, and the average molecular weight may be within a range of about 40 kDa to about 2000 kDa, with intermediate ranges having upper and lower limits defined as either 40 kDa, 70 kDa, 100 kDa, 1000 kDa, or 2000 kDa. The high molecular weight dextran may have a distribution of molecular weights, and the distribution of molecular weights may be narrow or broad. Since the refractive index is based on the weight of dextran per volume and the osmotic pressure can be determined by the number of solute particles per volume, the average molecular weight and the amount of dextran may be used to configure a dextran solution with the appropriate refractive index and osmotic pressure.

[0081] In many embodiments, the haptic structure is configured to orient the intraocular lens in position within the capsular bag of the patient's eye. In many embodiments, the haptic structure comprises an anterior haptic structure and a posterior haptic structure, the anterior haptic structure and the posterior structure coupled together and defining a fluid reservoir therebetween. In many embodiments, the haptic structure comprises an annular structure coupled to a peripheral region of the optical structure. The haptic structure may comprise a plurality of tab structures coupled to and distributed across a peripheral portion of the optical structure.

[0082] The peripheral portion may include a plurality of openings, and the haptic structure may be coupled to the peripheral portion through the plurality of openings. The plurality of openings may be oriented substantially parallel to the optical axis of the intraocular lens. Alternatively, or in combination, the plurality of openings may be oriented transverse to the optical axis of the intraocular lens. The haptic structure may include one or more posts or other structures for mounting through the plurality of openings of the peripheral portion of the optical structure to couple the haptic structure to the peripheral portion. Alternatively, or in combination, the optical structure may include posts for mating with structures such as openings of the haptic structure.

[0083] The intraocular lens may be sufficiently flexible to be folded into a reduced cross-section delivery configuration. The reduced cross-section delivery configuration of the intraocular lens may be achieved by folding or rolling the intraocular lens about a delivery axis perpendicular to the optical axis of the lens. Alternatively, or in combination, the reduced cross-section delivery configuration of the intraocular lens may be achieved by advancing the intraocular lens through a delivery tube or opening.

[0084] In many embodiments, the planar member is posterior to the plano-convex member when the intraocular lens is placed in the capsular bag.

[0085] Another aspect of the present disclosure provides a method of providing accommodation to a patient's eye. First, an intraocular lens may be provided. The provided intraocular lens may include an optical structure having a peripheral portion and a haptic structure. The optical structure may include a planar member, a plano-convex member coupled to the planar member at a peripheral portion, and a fluidic optical element defined between the planar member and the plano-convex member. The fluidic optical element may include a fluid having a refractive index similar to either or both of the materials included between the planar member and the plano-convex member. The fluidic optical element may have an optical power. The haptic structure may couple the planar member and the plano-convex member together at a peripheral portion of the optical structure. The haptic structure may include a fluid reservoir in fluid communication with the fluidic optical element and a peripheral structure for connecting to a capsular bag. Second, the intraocular lens may be folded into a reduced profile configuration. Third, the folded intraocular lens is implanted into a capsular bag of the patient's eye. The folded intraocular lens returns from the reduced profile configuration to an operating configuration when implanted into the capsular bag. Fourth, in response to deformation of the planar member, one or more of the optical structures or haptic structures may be actuated to cause one or more of a volume or shape change to the fluid optical element to modify the optical power of the fluid optical element.

[0086] One or more of the optical or haptic structures may be actuated by directing a force radially at the haptic structure to deform the planar member and modify the optical power of the fluidic optical element. The haptic peripheral structure may be rigidly coupled to the substantially planar member of the optical structure. The change in the optical power of the fluidic optical element may involve the movement of fluid from a fluid reservoir of the haptic structure into or out of the fluidic optical element. The movement of fluid from the haptic fluid chamber into or out of the fluidic optical element may deflect the planar member while the plano-convex member remains undeflected. In an alternative embodiment, the movement of fluid from the haptic fluid chamber into or out of the fluidic optical element may deflect the planar member and optionally the plano-convex member as well.

[0087] Actuating one or more of the optical structure and the tactile structure can be by imposing a force on the tactile fluid reservoir, reversibly deforming the tactile fluid reservoir to modify the optical power of the fluid optical element.

[0088] In many embodiments, the peripheral portion of the optical structure comprises a plurality of apertures, and the haptic structure connects the rear and front members together at the peripheral portion of the optical structure through the plurality of apertures. The haptic structure connected to the plurality of apertures in the peripheral portion can maintain the substantially planar member and the plano-convex member connected together when the intraocular lens is folded and during the function or operation of the intraocular lens. The plurality of apertures can be oriented substantially parallel to the optical axis of the intraocular lens. The plurality of apertures can be oriented transverse to the optical axis of the intraocular lens. The haptic structure comprises one or more struts for placement through the plurality of apertures and can connect the haptic structure to the peripheral region. Alternatively, or in combination, the peripheral portion of the optical structure has one or more apertures through which one or more struts of the haptic structure can pass and can connect the optical structure and the haptic structure together.

[0089] The intraocular lens can be folded into a configuration with a reduced profile by folding or rounding the intraocular lens around a delivery axis perpendicular to the optical axis of the lens. Alternatively, or in combination, the intraocular lens can be folded into a configuration with a reduced profile by advancing the intraocular lens through a delivery tube or aperture.

[0090] The folded intraocular lens can be implanted into the capsular bag by bringing the fluid in the lens fluid chamber into osmotic equilibrium with the fluid present in the capsular bag. One or more of the planar member or the plano-convex member may be water-permeable so that osmotic equilibrium can be achieved. In many embodiments, the porous rear or front member is impermeable to compounds having a molecular weight greater than 40 kDa.

[0091] In many embodiments, one or more of the planar member or the plano-convex member have substantially no optical power.

[0092] In many embodiments, the planar member is behind the plano-convex member when the intraocular lens is placed in the capsular bag.

[0093] In another aspect, an embodiment provides a method of making an accommodating intraocular lens. A first lens component is provided, the first lens component comprising a polymer. A second lens component is provided, the second lens component comprising a polymer. The first lens component is bonded to the second lens component with an adhesive. The adhesive may comprise a prepolymer of the polymer.

[0094] In many embodiments, the prepolymer is cured to bond the first lens component to the second lens component with the polymer extending between the first and second lens components.

[0095] In many embodiments, the first lens component and the second lens component each have a rigid configuration when the first lens component is bonded to the second lens component by a polymer extending between the first lens component and the second lens component.

[0096] In many embodiments, the first lens component is hydrated and the second lens component and the hardened adhesive are hydrated to provide a hydrated, soft, accommodating intraocular lens.

[0097] In many embodiments, hydrating the first lens component, the second lens component, and the adhesive includes fully hydrating the polymer of each of the components and the adhesive to an amount of hydration corresponding to the amount of hydration of the polymer when implanted.

[0098] In many embodiments, each of the first lens component, the second lens component, and the hardened adhesive has a rigid configuration before hydration and a flexible configuration when hydrated, and each of the first lens component, the second lens component, and the hardened adhesive expands a substantially similar amount from the first configuration to the second configuration to inhibit stresses at the interface between the adhesive and the first and second components.

[0099] Many embodiments further include providing a polymeric material and shaping the first lens component and the second lens component from the polymeric material.

[0100] In many embodiments, the first lens component and the second lens component are each machined on a lathe if rigid to shape the first lens component and the second lens component.

[0101] In many embodiments, the first lens component and the second lens component are molded.

[0102] In many embodiments, the prepolymer comprises one or more of a polymeric monomer, oligomer, partially cured monomer, particle, or nanoparticle.

[0103] In many embodiments, the first lens component comprises a disk-shaped structure and the second component comprises a disk-shaped structure, and the first component and the second component, when bonded together, define a chamber with the disk-shaped structure on an opposite side of the chamber.

[0104] In many embodiments, one or more of the first or second components includes a groove sized and shaped to receive the opposing component, and an adhesive is placed in the groove.

[0105] In many embodiments, one or more of the first component or the second component comprises an annular structure extending between the disk structure and the second disk structure to separate the first disk structure from the second disk structure and define a sidewall of the chamber.

[0106] In another aspect, an accommodating intraocular lens includes a first lens component, a second lens component, and an adhesive. The first lens component includes a polymer material. The second lens component includes a polymer material. The hardened adhesive bonds the first lens component to the second lens component and includes a polymer between at least a portion of the first component and the second component to define a chamber.

[0107] In many embodiments, the chamber comprises an optical element.

[0108] Many embodiments further include a fluid in the chamber having a refractive index greater than the refractive index of the aqueous humor of the eye, which is about 1.336, and one or more of the first component or second component are configured to deform to increase the optical power of the accommodating intraocular lens.

[0109] Many embodiments further include one or more haptics for engaging a capsular bag wall of the eye and increasing the curvature of one or more of the first or second lens components in response to a contracting capsular bag wall to increase the optical power of the accommodating intraocular lens.

[0110] Many embodiments further include a fluid, the fluid comprising one or more of a solution, an oil, a silicone, an oil, a solution of high molecular weight molecules, or a high molecular weight dextran.

[0111] Many embodiments further include a seam comprising an adhesive, the seam extending circumferentially along at least a portion of the first component and the second component.

[0112] In many embodiments, the first lens component comprises a first disc-shaped structure and the second lens component comprises a second disc-shaped structure on an opposite side of the chamber, with the annular structure extending between and separating the first disc-shaped structure from the second disc-shaped structure and defining the chamber.

[0113] In many embodiments, the intraocular lens has a rigid configuration prior to implantation and a flexible configuration once implanted.

[0114] In many embodiments, the first lens component comprises a first disk-shaped optical structure comprising one or more of a lens, a meniscus, a meniscus lens, or a flat plate, and the second lens component comprises a second disk-shaped optical structure comprising one or more of a lens, a meniscus, a meniscus lens, or a flat plate.

[0115] Yet another aspect of the present disclosure provides an intraocular lens for implantation within a capsular bag of a patient's eye. The intraocular lens may comprise an optical structure and a haptic structure. The optical structure may have a peripheral portion and may comprise a posterior member, an anterior member coupled to the posterior member at the peripheral portion, and a fluid optical element defined between the posterior and anterior members. The fluid optical element may include a fluid having a refractive index similar to either or both of the materials comprising the posterior and anterior members. The fluid optical element may have an optical power. The haptic structure may couple the posterior and anterior members at the peripheral portion of the optical structure. The haptic structure may comprise a fluid reservoir in fluid communication with the fluid optical element and a peripheral structure for connecting to the capsular bag. A shape change of the capsular bag may result in a volume or shape change to the fluid optical element in response to deformation in one or more of the posterior or anterior members to modify the optical power of the fluid optical element. One or more of the posterior or anterior members of the optical structure may be water permeable such that moisture present in the capsular bag of a patient's eye may move therethrough into or out of the fluid lens chamber to achieve osmotic equilibrium with fluid present in the capsular bag when the intraocular lens is placed therein. Various features of the intraocular lens may be further configured in a number of ways in the many embodiments disclosed herein.

[0116] In another aspect of the present disclosure, an implantable intraocular lens is provided. The intraocular lens may comprise a fluid chamber and an optical structure having a material within the fluid chamber. The material may have a non-fully hydrated state. A portion of the optical structure may be configured to provide water to the fluid chamber and prevent leakage of the material from the fluid chamber in order to fully hydrate the material and expand the fluid chamber when the optical structure is placed in the eye.

[0117] In yet another aspect of the present disclosure, a method of implanting an artificial lens into the lens capsule of a patient's eye is provided. The method may include advancing an intraocular lens having a non-fully hydrated configuration through an incision in the eye. Moisture from the lens capsule may pass through at least a portion of the optical structure to fully hydrate the intraocular lens. In many embodiments, the material within the fluid chamber of the optical structure of the intraocular lens may be prevented from leaking out of at least a portion of the optical structure, but moisture from the lens capsule may be able to pass through to fully hydrate the material. Incorporation by reference

[0118] All publications, patents, and patent applications described herein are hereby incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference. The present invention provides, for example, the following. (Item 1) An adjustable intraocular lens for placement within a lens capsule of a subject, a first component having an inner region and an outer region, a second component having an inner region and an outer region, the second component being connected to the first component, a fluid chamber defined between inner surfaces of the inner regions of the first and second components, a fluid reservoir defined between inner surfaces of the outer regions of the first and second components, the fluid reservoir being in fluid communication with the fluid chamber and configured to move fluid between the fluid chamber and the fluid reservoir in response to a change in shape of the lens capsule, thereby causing a change in the optical power of the adjustable intraocular lens. a third component having an optical power and connected to the first or second component, the third component having an inner surface facing and adjacent to an outer surface of the first or second component to which the third component is connected. (Item 2) Item 1. The accommodating intraocular lens of item 1, wherein one or more of the interior region of the first component or the interior region of the second component comprises a planar member. (Item 3) 2. The accommodating intraocular lens of item 1, wherein one or more of the internal regions of the first component or the second component are configured to deflect in response to fluid movement between the fluid chamber and the fluid reservoir. (Item 4) 4. The accommodating intraocular lens of claim 3, wherein deflection of one or more of the interior regions of the first component or the second component effects at least a portion of the optical power change. (Item 5) 5. The accommodating intraocular lens of item 4, wherein deflection of one or more of the internal regions of the first component or the second component changes one or more of the dimensions or shapes of the fluid chambers, resulting in at least the portion of the optical power change. (Item 6) 6. The accommodating intraocular lens of claim 5, wherein the change to one or more of the dimensions or shapes of the fluid chamber comprises a separation distance between the inner surfaces of the interior regions of the first and second components. (Item 7) 2. The accommodating intraocular lens of claim 1, wherein the third component is coupled to the second component, and the interior region of the first component comprises a deflectable member configured to deflect in response to the fluid movement between the fluid chamber and the fluid reservoir. (Item 8) Item 1 , the accommodating intraocular lens of item 1, wherein the first component is bonded to the second component at a joint. (Item 9) 2. The accommodating intraocular lens of claim 1, further comprising a protrusion on the inner surface of one or more of the first component or the second component to provide a gap between the first component and the second component. (Item 10) Item 1 , the accommodating intraocular lens of item 1, wherein the first component is bonded to the second component at a junction that extends circumferentially around the first and second components. (Item 11) 2. The accommodating intraocular lens of claim 1, wherein the outer regions of the first and second components extend continuously and circumferentially around the inner regions of the first and second components, respectively. (Item 12) 2. The accommodating intraocular lens of item 1, wherein the outer region of the first component comprises one or more folds that extend continuously and circumferentially around the optical axis of the outer region of the first component, and the outer region of the second component comprises one or more folds that extend continuously and circumferentially around the optical axis of the outer region of the second component. (Item 13) Item 13. The accommodating intraocular lens of item 12, wherein the one or more folds of the external region of the first component and the one or more folds of the external region of the second component extend toward one another to define a plurality of bellows, and the fluid reservoir comprises the plurality of bellows. (Item 14) 2. The accommodating intraocular lens of claim 1, wherein the first component comprises a first annular shaped rigid coupling structure extending circumferentially between the inner and outer regions to inhibit radial movement of the outer region with radial movement of the inner region, and the second component comprises a second annular shaped rigid coupling structure extending circumferentially between the inner and outer regions to inhibit radial movement of the inner region with radial movement of the outer region, the first annular shaped structure having a first radial thickness greater than a first thickness of the outer region of the first component, and the second annular shaped structure having a second radial thickness greater than a second thickness of the outer region of the second component. (Item 15) Item 2. The accommodating intraocular lens of item 1, wherein the first component comprises an anterior component and the second component comprises a posterior component. (Item 16) Item 1. The accommodating intraocular lens of item 1, wherein one or more of the interior region of the first component or the interior region of the second component comprises a shell. (Item 17) 2. The accommodating intraocular lens of item 1, wherein one of the interior region of the first component or the interior region of the second component comprises a planar member and the other of the interior regions comprises a plano-convex member shaped to provide an optical power. (Item 18) 2. The accommodating intraocular lens of claim 1, wherein the fluid in the fluid chamber shapes the fluid chamber to provide an optical power. (Item 19) 20. The accommodating intraocular lens of claim 1, wherein a protrusion located between the inner and outer regions of the first and second components connects the first component to the second component, the protrusion being located on one or more rigid connecting structures of one or more of the first or second components to provide a gap between the first and second components. Item 1. The accommodating intraocular lens of item 1, wherein the fluid reservoir comprises a conforming fold region between an inner bellows region and an outer bellows region, the conforming fold region being thinner than the inner and outer bellows. (Item 21) 2. The accommodating intraocular lens of item 1, further comprising a plurality of protrusions coupled to one or more of the first or second components and separating the first and second components from one another. (Item 22) 22. The accommodating intraocular lens of claim 21, wherein the plurality of protrusions are located between the inner and outer regions of the first and second components. (Item 23) 22. The accommodating intraocular lens of claim 21, wherein the plurality of protrusions define a plurality of fluid channels between the fluid chamber and the fluid reservoir, and each of the plurality of fluid channels is defined between two adjacent protrusions. (Item 24) Item 1. The accommodating intraocular lens of item 1, wherein one or more of the first or second components comprises a polymer material. (Item 25) 26. The accommodating intraocular lens of claim 24, wherein the polymeric material comprises a PMMA copolymer. 25. The accommodating intraocular lens of claim 24, wherein the polymeric material is water permeable. (Item 27) 25. The accommodating intraocular lens of claim 24, wherein the polymeric material is hydrophilic. (Item 28) 25. The accommodating intraocular lens of claim 24, wherein the polymeric material is configured to move water within the subject's lens capsule through the polymeric material and into or out of one or more of the fluid chambers or reservoirs to achieve osmotic equilibrium when the accommodating intraocular lens is placed within the lens capsule. (Item 29) 25. The accommodating intraocular lens of claim 24, wherein the polymeric material is impermeable to compounds having a molecular weight greater than 40 kDa. (Item 30) 2. The accommodating intraocular lens of item 1, further comprising a fluid in the fluid chamber, the fluid comprising one or more of a solution, an oil, a silicone oil, a solution of dextran, a solution of high molecular weight dextran, or a solution of another high molecular weight compound. (Item 31) Item 1. The accommodating intraocular lens of item 1, wherein the fluid reservoir comprises a continuous baffle structure positioned around the outer edge of the fluid chamber. (Item 32) 32. The accommodating intraocular lens of claim 31, wherein the continuous baffle structure comprises one or more of annular, elliptical, or rotationally symmetric shapes. (Item 33) 2. The accommodating intraocular lens of item 1, wherein the first and second components are sufficiently flexible to be folded into a reduced cross-section delivery configuration. (Item 34) 34. The accommodating intraocular lens of claim 33, wherein the reduced cross-sectional delivery configuration comprises one or more folds or rolls of the intraocular lens about a delivery axis transverse to the optical axis of the accommodating intraocular lens. (Item 35) Item 34. The accommodating intraocular lens of item 33, further comprising a delivery tube or aperture, the reduced cross-section delivery configuration comprising the intraocular lens advanced into the delivery tube or aperture. (Item 36) Item 1. The accommodating intraocular lens of item 1, wherein the fluid reservoir comprises a haptic structure that engages the lens capsule. (Item 37) 2. The accommodating intraocular lens of claim 1, wherein the fluid in the fluid chamber has a refractive index greater than the refractive index of the aqueous humor of the eye, which is about 1.336. (Item 38) 2. The accommodating intraocular lens of item 1, wherein one or more of the interior regions of the first component or the second component are biased to a configuration that provides no optical power. (Item 39) Item 2. The accommodating intraocular lens of item 1, wherein the fluid in the fluid chamber provides an optical power. (Item 40) Item 1. The accommodating intraocular lens of item 1, wherein the first and second components are bonded to one another. (Item 41) Item 41. The accommodating intraocular lens of item 40, wherein the first and second components comprise a polymeric material, and the first and second components are bonded with a prepolymer of the polymeric material. (Item 42) Item 1. The accommodating intraocular lens of item 1, wherein one or more of the first component or the second component are directly fabricated. (Item 43) Item 2. The accommodating intraocular lens of item 1, wherein the first component and the second component are fabricated directly together and form a single piece. (Item 44) Item 1. The accommodating intraocular lens of item 1, wherein the first component and the second component are molded separately and bonded together. (Item 45) Item 2. The accommodating intraocular lens of item 1, wherein the first component and the second component are lathed separately and bonded together. (Item 46) Item 1 , the accommodating intraocular lens of item 1, wherein the first component and the second component are joined together at a protrusion extending therebetween. (Item 47) Item 1. The accommodating intraocular lens of item 1, wherein the first component comprises a first fabricated part and the second component comprises a second fabricated part. (Item 48) Item 1. The accommodating intraocular lens of item 1, wherein the outer edge of the third component is within the outer edge of one or more of the first or second components. (Item 49) Item 2. The accommodating intraocular lens of item 1, wherein the third component is configured to snap-fit ​​onto the first or second lens component. (Item 50) Item 1. The accommodating intraocular lens of item 1, further comprising a fourth component configured to connect the first and second components to each other at their outer edges. (Item 51) Item 51. The accommodating intraocular lens of item 50, wherein the fourth component comprises a thin-walled ring. (Item 52) Item 52. The accommodating intraocular lens of item 51, wherein the thin-walled ring and the outer region of the first and second components together define the fluid reservoir. (Item 53) A method comprising providing an accommodating intraocular lens according to any one of the preceding claims. (Item 54) 1. A method of implanting an accommodating intraocular lens, comprising: positioning an accommodating portion of an accommodating intraocular lens within a subject's capsular bag, the accommodating portion being configured to change its optical power in response to movement of the capsular bag when positioned therein; positioning a fixed optic portion of the accommodating intraocular lens within the capsular bag, the fixed optic portion having a fixed optical power; and coupling the accommodative portion to the fixed optic portion within the lens capsule, the accommodative portion and the fixed optic portion combining to provide optical correction and accommodation to the subject's eye. (Item 55) 55. The method of claim 54, further comprising the step of selecting the fixed optical portion from a plurality of fixed optical portions, the fixed optical portions of the plurality of fixed optical portions having different optical powers from one another. (Item 56) 56. The method of claim 55, further comprising measuring one or more of the optical power or accommodation range of the eye with the accommodative portion of the accommodative intraocular lens positioned within the capsular bag. (Item 57) Item 57. The method of item 56, wherein the fixed optical portion is selected based on the measured one or more of the optical power or accommodation range. (Item 58) Item 58. The method of item 57, wherein the fixed optical portion is selected to compensate for one or more of the optical power or accommodation range of the eye with the accommodation portion positioned within the lens capsule. (Item 59) 56. The method of claim 55, further comprising the step of removing a cataract from the capsular bag prior to positioning the accommodation and fixation optic portion of the accommodating intraocular lens therein. (Item 60) Item 56. The method of item 55, wherein the adjustment portion comprises a fluid chamber, the fluid chamber configured to provide optical power and accommodation to the adjustment portion. (Item 61) Item 61. The method of item 60, wherein the fluid chamber is configured to change one or more of size or shape in response to movement of the lens capsule to provide the accommodation. (Item 62) Item 62. The method of item 61, wherein the adjustment portion comprises a fluid reservoir in fluid communication with the fluid chamber, the fluid reservoir providing fluid to the fluid chamber to compensate for changes to one or more of the size or shape of the fluid chamber. (Item 63) Item 63. The method of item 62, wherein the fluid reservoir comprises one or more bellows. (Item 64) Item 63. The method of item 62, wherein the fluid reservoir is positioned along a circumference of the adjustment portion. (Item 65) Item 65. The method of item 64, wherein the fixed optical portion, when coupled to the adjustment portion, is positioned within a boundary defined by the fluid reservoir. (Item 66) Item 56. The method of item 55, wherein the fixed optical portion comprises a plano-convex member. (Item 67) Item 56. The method of item 55, wherein the fixed optical portion is positioned across an anterior or posterior surface of the accommodation portion. (Item 68) Item 56. The method of item 55, wherein coupling the accommodative portion together with the fixation optic portion within the capsular bag comprises bonding the accommodative and fixation optic portions together. (Item 69) A plurality of lens components arranged to be assembled together in-situ within the eye to form the accommodating intraocular lens. (Item 70) Item 71. The accommodating intraocular lens according to item 70, wherein the plurality of components are: a first component having an inner region and an outer region; a second component coupled to the first component, the second component having an interior region and an exterior region; a fluid chamber defined between inner surfaces of the interior regions of the first and second components; a fluid reservoir defined between inner surfaces of the outer regions of the first and second components, the fluid reservoir in fluid communication with the fluid chamber to move fluid between the fluid chamber and the fluid reservoir in response to a shape change of the lens capsule to provide an optical power change to the accommodating intraocular lens; and a third component having an optical power and coupled to the first or second component, the third component having an inner surface facing and adjacent to an outer surface of the first or second component to which the third component is coupled. (Item 71) Item 71. The accommodating intraocular lens of item 70, wherein one or more of the interior region of the first component or the interior region of the second component comprises a planar member. (Item 72) 71. The accommodating intraocular lens of item 70, wherein one or more of the internal regions of the first component or the internal regions of the second component are configured to deflect in response to the fluid movement between the fluid chamber and the fluid reservoir. (Item 73) 73. The accommodating intraocular lens of claim 72, wherein deflection of one or more of the interior regions of the first component or the second component effects at least a portion of the optical power change. (Item 74) the deflection of one or more of the interior region of the first component or the interior region of the second component changes one or more of a size or shape of the fluid chamber; Item 74. The accommodating intraocular lens of item 73, which provides at least a portion of the optical power change. (Item 75) 75. The accommodating intraocular lens of claim 74, wherein the change to one or more of the dimensions or shapes of the fluid chamber comprises a separation distance between the inner surfaces of the interior regions of the first and second components. (Item 76) 71. The accommodating intraocular lens of claim 70, wherein the third component is coupled to the second component, and the interior region of the first component comprises a deflectable member configured to deflect in response to the fluid movement between the fluid chamber and the fluid reservoir. (Item 77) Item 71. The accommodating intraocular lens of item 70, wherein the first component is bonded to the second component at a joint. (Item 78) Item 71. The accommodating intraocular lens of item 70, comprising a protrusion on the inner surface of one or more of the first component or the second component to provide a gap between the first component and the second component. (Item 79) Item 71. The accommodating intraocular lens of item 70, wherein the first component is bonded to the second component at a junction that extends circumferentially around the first and second components. (Item 80) Item 71. The accommodating intraocular lens of item 70, wherein the outer regions of the first and second components extend continuously and circumferentially around the inner regions of the first and second components, respectively. (Item 81) 71. The accommodating intraocular lens of claim 70, wherein the outer region of the first component comprises one or more folds that extend continuously and circumferentially around the optical axis of the outer region of the first component, and the outer region of the second component comprises one or more folds that extend continuously and circumferentially around the optical axis of the outer region of the second component. (Item 82) Item 82. The accommodating intraocular lens of item 81, wherein the one or more folds of the external region of the first component and the one or more folds of the external region of the second component extend toward one another to define a plurality of bellows, and the fluid reservoir comprises the plurality of bellows. (Item 83) 71. The accommodating intraocular lens of claim 70, wherein the first component comprises a first annular shaped rigid connecting structure extending circumferentially between the inner and outer regions to inhibit radial movement of the outer region with radial movement of the inner region, and the second component comprises a second annular shaped rigid connecting structure extending circumferentially between the inner and outer regions to inhibit radial movement of the inner region with radial movement of the outer region, the first annular shaped structure having a first radial thickness greater than a first thickness of the outer region of the first component, and the second annular shaped structure having a second radial thickness greater than a second thickness of the outer region of the second component. (Item 84) Item 71. The accommodating intraocular lens of item 70, wherein the first component comprises an anterior component and the second component comprises a posterior component. (Item 85) Item 71. The accommodating intraocular lens of item 70, wherein one or more of the interior region of the first component or the interior region of the second component comprises a shell. (Item 86) Item 71. The accommodating intraocular lens of item 70, wherein one of the interior region of the first component or the interior region of the second component comprises a planar member and the other of the interior regions comprises a plano-convex member shaped to provide an optical power. (Item 87) Item 71. The accommodating intraocular lens of item 70, wherein the fluid in the fluid chamber shapes the fluid chamber to provide an optical power. (Item 88) 71. The accommodating intraocular lens of item 70, wherein a protrusion located between the inner and outer regions of the first and second components connects the first component to the second component, the protrusion being located on one or more rigid connecting structures of one or more of the first or second components and providing a gap between the first component and the second component. (Item 89) Item 71. The accommodating intraocular lens of item 70, wherein the fluid reservoir comprises a conforming fold region between an inner bellows region and an outer bellows region, the conforming fold region being thinner than the inner and outer bellows. (Item 90) 71. The accommodating intraocular lens of claim 70, further comprising a plurality of protrusions coupled to one or more of the first or second components and separating the first and second components from one another. (Item 91) Item 91. The accommodating intraocular lens of item 90, wherein the plurality of protrusions are located between the inner and outer regions of the first and second components. (Item 92) The accommodating intraocular lens of item 90, wherein the plurality of protrusions define a plurality of fluid channels between the fluid chamber and the fluid reservoir, and each of the plurality of fluid channels is defined between two adjacent protrusions. (Item 93) Item 71. The accommodating intraocular lens of item 70, wherein one or more of the first or second components comprises a polymeric material. (Item 94) Item 95. The accommodating intraocular lens of item 93, wherein the polymeric material comprises a PMMA copolymer. Item 94. The accommodating intraocular lens of item 93, wherein the polymeric material is water permeable. (Item 96) Item 94. The accommodating intraocular lens of item 93, wherein the polymeric material is hydrophilic. (Item 97) The accommodating intraocular lens of item 93, wherein the polymer material is configured to move water within the subject's lens capsule through the polymer material and into or out of one or more of the fluid chambers or fluid reservoirs to achieve osmotic equilibrium when the accommodating intraocular lens is placed within the lens capsule. (Item 98) 94. The accommodating intraocular lens of claim 93, wherein the polymeric material is impermeable to compounds having a molecular weight greater than 40 kDa. (Item 99) 71. The accommodating intraocular lens of claim 70, further comprising a fluid in the fluid chamber, the fluid comprising one or more of a solution, an oil, a silicone oil, a solution of dextran, a solution of high molecular weight dextran, or a solution of another high molecular weight compound. (Item 100) Item 71. The accommodating intraocular lens of item 70, wherein the fluid reservoir comprises a continuous baffle structure positioned around the outer edge of the fluid chamber. (Item 101) Item 101. The accommodating intraocular lens of item 100, wherein the continuous baffle structure comprises one or more of annular, elliptical, or rotationally symmetric shapes. (Item 102) Item 71. The accommodating intraocular lens of item 70, wherein the first and second components are sufficiently flexible to be folded into a reduced cross-section delivery configuration. (Item 103) The accommodating intraocular lens of item 102, wherein the reduced cross-sectional delivery configuration comprises one or more folds or rolls of the intraocular lens about a delivery axis transverse to the optical axis of the accommodating intraocular lens. (Item 104) Item 103. The accommodating intraocular lens of item 102, further comprising a delivery tube or aperture, the reduced cross-section delivery configuration comprising the intraocular lens advanced into the delivery tube or aperture. (Item 105) Item 71. The accommodating intraocular lens of item 70, wherein the fluid reservoir comprises a haptic structure that engages the lens capsule. (Item 106) Item 71. The accommodating intraocular lens of item 70, wherein the fluid in the fluid chamber has a refractive index greater than the refractive index of the aqueous humor of the eye, which is about 1.336. (Item 107) The accommodating intraocular lens of item 70, wherein one or more of the interior regions of the first component or the interior regions of the second component are biased to a configuration that provides no optical power. (Item 108) Item 71. The accommodating intraocular lens of item 70, wherein the fluid in the fluid chamber provides an optical power. (Item 109) Item 71. The accommodating intraocular lens of item 70, wherein the first and second components are bonded to one another. (Item 110) Item 110. The accommodating intraocular lens of item 109, wherein the first and second components comprise a polymeric material, and the first and second components are bonded to a prepolymer of the polymeric material. (Item 111) Item 71. The accommodating intraocular lens of item 70, wherein one or more of the first component or the second component are directly fabricated. (Item 112) Item 71. The accommodating intraocular lens of item 70, wherein the first component and the second component are fabricated directly together and form a single piece. (Item 113) Item 71. The accommodating intraocular lens of item 70, wherein the first component and the second component are molded separately and bonded together. (Item 114) Item 71. The accommodating intraocular lens of item 70, wherein the first component and the second component are lathed separately and bonded together. (Item 115) Item 71. The accommodating intraocular lens of item 70, wherein the first component and the second component are joined together at a protrusion extending therebetween. (Item 116) Item 71. The accommodating intraocular lens of item 70, wherein the first component comprises a first fabricated part and the second component comprises a second fabricated part. (Item 117) Item 71. The accommodating intraocular lens of item 70, wherein the outer edge of the third component is within the outer edge of one or more of the first or second components. (Item 118) Item 71. The accommodating intraocular lens of item 70, wherein the third component is configured to snap-fit ​​onto the first or second lens component. (Item 119) Item 71. The accommodating intraocular lens of item 70, further comprising a fourth component configured to join the first and second components to one another at their outer edges. (Item 120) Item 120. The accommodating intraocular lens of item 119, wherein the fourth component comprises a thin-walled ring. (Item 121) Item 121. The accommodating intraocular lens of item 120, wherein the thin-walled ring and the outer region of the first and second components together define the fluid reservoir. (Item 122) A method comprising providing an accommodating intraocular lens according to any one of items 69 to 122. (Item 123) 1. An accommodating intraocular lens assembly for placement within a capsular bag of a subject, comprising: an accommodative lens unit having a first optical component and a second optical component posterior to the first optical component, the first optical component and / or the second optical component being flexible such that bending of the first optical component and / or the second optical component changes the optical power of the accommodative lens unit; an accommodative intraocular lens assembly comprising: a corrective lens having an optical power, the corrective lens being configured to be removably coupled to the accommodative lens unit such that the corrective lens is in front of and spaced from the first optical component of the accommodative lens unit; (Item 124) Item 124. An accommodating intraocular lens assembly as described in item 123, wherein the first optical component is flexible and the corrective lens is spaced from the first optical component by a gap configured to allow the first optical component to bend forward sufficiently to provide a desired optical power for accommodation. (Item 125) Item 125. An accommodating intraocular lens assembly as described in item 124, wherein the corrective lens further includes a passage configured to allow body fluid to flow in and out of a gap between the corrective lens and the first optical component. (Item 126) Item 124. The accommodating intraocular lens assembly of item 123, wherein the accommodating lens unit further comprises a fixed lens receptor, the corrective lens being snap-fitted into the fixed lens receptor. (Item 127) Item 124. The accommodating intraocular lens assembly of item 123, wherein the accommodating lens unit further comprises a fluid chamber between the first optical component and the second optical component, a reservoir fluidly connected to the fluid chamber, and a flowable optical element within the fluid chamber and the reservoir, and wherein the first optical component and / or the second optical component bend in response to the optical element flowing between the fluid chamber and the reservoir to change the optical power. (Item 128) Item 128. The accommodating intraocular lens assembly according to item 127, wherein: the adjustable lens unit further comprises a first structural element having the first optical component, a first outer portion around the first optical component, a second structural element having the second optical component, and a second outer portion around the second optical component, the first and second structural elements being coupled together to form the fluid chamber between the first optical component and the second optical component, and the reservoir between the first outer element and the second outer element; An accommodating intraocular lens assembly, wherein the corrective lens is attached to the first outer portion of the first structural element. (Item 129) Item 128. An accommodating intraocular lens assembly as described in item 127, wherein the first optical component is deflectable and the second optical component is at least substantially rigid such that forward deflection of the first optical component and the flowable optical member of the fluid chamber provides optical power adjustment. (Item 130) Item 128. An accommodating intraocular lens assembly as described in item 127, wherein the reservoir defined by the first and second outer portions of the first and second structural elements is an annular bellows, and the flowable optical member flows between the annular bellows and the fluid chamber. (Item 131) Item 124. An accommodating intraocular lens assembly as described in Item 123, wherein the corrective lens comprises a toric lens having alignment features configured to align the toric lens to an optical axis. (Item 132) 1. An accommodating intraocular lens assembly comprising: an accommodative lens unit having a first optical component, a second optical component posterior to the first optical component, an optical fluid between the first optical component and the second optical component, a wall protruding annularly from the first optical component, and retention features along the wall anterior to the first and second optical components, wherein the first optical component and / or the second optical component are flexible such that bending of the first optical component and / or the second optical component in combination with the optical fluid between the first optical component and the second optical component changes the optical power of the accommodative lens unit; an accommodating intraocular lens assembly comprising: a corrective lens having a certain optical power, the corrective lens being configured to be removably coupled in-situ in the eye to retention features along the wall after the accommodating lens unit is implanted in the eye. (Item 133) Item 133. An accommodating intraocular lens assembly as described in item 132, wherein the first optical component is flexible and the corrective lens is spaced from the first optical component by a gap configured to allow the first optical component to bend forward sufficiently to provide a desired optical power for accommodation. (Item 134) Item 133. An accommodating intraocular lens assembly as described in Item 132, wherein the corrective lens further includes a passage configured to allow body fluid to flow into and out of the gap between the corrective lens and the first optical component. (Item 135) Item 133. The accommodating intraocular lens assembly of item 132, wherein the accommodating lens unit further comprises a fixed lens receptor, the corrective lens being snap-fitted into the fixed lens receptor. (Item 136) Item 133. An accommodating intraocular lens assembly as described in Item 132, wherein the accommodating lens unit further comprises a fluid chamber between the first optical component and the second optical component, a reservoir fluidly connected to the fluid chamber, and an optical fluid within the fluid chamber and the reservoir, wherein the first optical component and / or the second optical component bend in response to the optical fluid flowing between the fluid chamber and the reservoir such that a change in the volume of the optical fluid in the fluid chamber changes the optical power. (Item 137) Item 137. The accommodating intraocular lens assembly of item 136, comprising: the adjustable lens unit further comprises a first structural element having the first optical component and a first outer portion about the first optical component, and a second structural element having the second optical component and a second outer portion about the second optical component, the first and second structural elements being coupled together to form the fluid chamber between the first optical component and the second optical component, and the reservoir between the first and second outer elements; An accommodating intraocular lens assembly, wherein the corrective lens is attached to the first outer portion of the first structural element. (Item 138) Item 137. An accommodating intraocular lens assembly as described in item 136, wherein the first optical component is deflectable and the second optical component is at least substantially rigid such that forward deflection of the first optical component provides an optical power adjustment. (Item 139) Item 137. An accommodating intraocular lens assembly as described in Item 136, wherein the reservoir defined by the first and second outer portions of the first and second structural elements is an annular bellows, and the optical fluid flows between the annular bellows and the fluid chamber. (Item 140) Item 133. An accommodating intraocular lens assembly as described in Item 132, wherein the corrective lens comprises a toric lens having alignment features configured to align the toric lens to an optical axis. (Item 141) 1. A method of implanting an accommodating intraocular lens assembly, comprising: placing an accommodative lens unit within a capsule of the eye, the accommodative lens unit comprising a first optical component and a second optical component posterior to the first optical component, the first optical component and / or the second optical component being flexible such that bending of the first optical component and / or the second optical component dynamically changes the optical power of the accommodative lens unit; and removably connecting a corrective lens to the adjustable lens unit anterior to the first and second optical components, the corrective lens having an optical power. (Item 142) Item 142. The method of item 141, further comprising the step of effecting accommodation by flowing a fluid within the adjustable lens unit between the first optical component and the second optical component such that the first optical component and / or the second optical component bend away from the other. (Item 143) Item 143. The method of item 142, wherein the first optical component bends forward into a gap between the first optical component and the corrective lens, and the second optical component is at least substantially rigid. (Item 144) Item 142. The method of item 141, further comprising the steps of removing the corrective lens from the accommodative lens unit in situ and removably connecting another corrective lens having a different optical power to the accommodative lens unit. (Item 145) Item 142. The method of item 141, further comprising the steps of determining a desired fixed correction power for a patient and selecting the corrective lens to have the desired fixed correction power. [Brief description of the drawings]

[0119] The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings.

[0120] [Figure 1] FIG. 1 illustrates an accommodating intraocular lens (AIOL) system, according to many embodiments. [Diagram 2] FIG. 2 illustrates a side view of a lens support structure and lens, according to many embodiments. [Diagram 3] FIG. 3 illustrates a cross-sectional view of a lens support structure incorporating a threaded lens contact surface, according to many embodiments. [Figure 4] FIG. 4 illustrates a cross-sectional view of a lens support structure incorporating a lens interfaced using an interference fit, according to many embodiments. [Diagram 5] FIG. 5 illustrates an AIOL in which half of the support and haptic structures are contained in the top and bottom halves of the AIOL, all made from the same material, according to many embodiments. [Figure 6] FIG. 6 illustrates an AIOL in which the haptics and support structure are integral and configured as a ring-like structure, according to many embodiments. [Figure 7] FIG. 7 illustrates a variation of the AIOL of FIG. 6 that incorporates features that aid in reducing the delivery cross-section, according to many embodiments. [Figure 8] FIG. 8 illustrates an AIOL with a fluid-filled, resilient support structure that can be hardened after delivery of the AIOL, according to many embodiments. [Figure 9] 9A, 9B, and 9C show alternative folding lens support structures, according to many embodiments. [Figure 10]10 through 14B illustrate alternative AIOL configurations in which the AIOL is inserted into and contacts the natural capsule such that the attachment area seals against a semi-annular region of the capsule and fluid movement between the semi-annular region and the interior of the AIOL results in accommodative changes in the AIOL, according to many embodiments. FIG 10 shows an AIOL with an alternative haptic configuration in which fluid chambers are formed by sealing against the equatorial and posterior regions of the capsular bag incorporating one optic, according to many embodiments. [Figure 11] 10 through 14B illustrate alternative AIOL configurations in which the AIOL is inserted into and contacts the natural capsule such that the attachment area seals against a semi-annular region of the capsule and fluid movement between the semi-annular region and the interior of the AIOL results in accommodative changes in the AIOL, according to many embodiments. FIG 11 shows an AIOL with an alternative haptic structure in which fluid chambers are formed by sealing against the equatorial and posterior regions of the lens capsule incorporating two optics, according to many embodiments. [Figure 12] 10 through 14B illustrate alternative AIOL configurations in which the AIOL is inserted into and contacts the natural capsule such that the attachment area seals against a semi-annular region of the capsule and fluid movement between the semi-annular region and the interior of the AIOL results in accommodative changes in the AIOL, according to many embodiments. FIG 12 shows an AIOL with an alternative haptic configuration in which fluid chambers are formed by a thin membrane that seals against the equatorial and posterior regions of the lens capsule incorporating two optics, according to many embodiments. [Figure 13] 10 through 14B illustrate alternative AIOL structures in which the AIOL is inserted into and contacts the natural capsule such that the attachment area seals against a semi-annular region of the capsule and fluid movement between the semi-annular region and the interior of the AIOL results in accommodative changes in the AIOL, according to many embodiments. FIG 13 shows an AIOL with an alternative haptic structure in which fluid chambers are formed by a thin membrane and by sealing against the equatorial and posterior regions of the capsular bag incorporating one optic, according to many embodiments. [Figure 14A]10 through 14B illustrate alternative AIOL configurations in which the AIOL is inserted into and contacts the native capsule such that the attachment area seals against a semi-annular region of the capsule and fluid movement between the semi-annular region and the interior of the AIOL results in accommodation changes in the AIOL, according to many embodiments. FIG 14A illustrates the alternative embodiment after implantation of the AIOL, according to many embodiments. [Figure 14B] 10 through 14B illustrate alternative AIOL configurations in which the AIOL is inserted into and contacts the natural capsule such that the attachment area seals against a semi-annular region of the capsule and fluid movement between the semi-annular region and the interior of the AIOL results in accommodative changes in the AIOL, according to many embodiments. FIG 14B illustrates the installed AIOL of FIG 14A post-operatively with the capsular bag conforming to the installed device, according to many embodiments. [Figure 15] FIG. 15 illustrates an optical structure comprising a front surface and a rear surface, according to many embodiments. [Figure 16A] FIG. 16A illustrates a lens support structure bonded to an optical structure prior to bonding, according to many embodiments. [Figure 16B] FIG. 16B depicts the final AIOL with points bonded together to provide a seal along the perimeter, according to many embodiments. [Figure 17] FIG. 17 depicts the AIOL of FIG. 16B with the addition of an alternative posterior opacifying cell dam and an anterior capsulotomy support, in accordance with many embodiments. [Figure 18] FIG. 18 illustrates an alternative AIOL, according to many embodiments. [Figure 19] FIG. 19 illustrates an alternative optical configuration, according to many embodiments. [Figure 20] FIG. 20 is a top cross-sectional view of an AIOL incorporating the optical assembly shown in FIG. [Figure 21A] FIG. 21A is a side cross-sectional view of the AIOL of FIG. [Figure 21B] FIG. 21B illustrates a modeling of the haptic structures of FIGS. 20-22 under radial and pressure loads associated with forces generated by the capsular structure of the eye, according to many embodiments. [Figure 22]FIG. 22 is a diagram of a final AIOL assembly constructed from the elements shown in FIGS. 19-21, in accordance with many embodiments. [Diagram 23] 23A and 23B illustrate an alternative AIOL embodiment and method of manufacture, according to many embodiments. [Figure 24] FIG. 24 illustrates an alternative low profile AIOL having alternative haptic and support structures, according to many embodiments. [Figure 25A] FIG. 25A is a model of adjustability of an AIOL similar to FIG. 24, according to many embodiments. [Figure 25B] 25B and 25C show cross-sectional perspective views of the AIOL of FIG. 25A. [Figure 25C] 25B and 25C show cross-sectional perspective views of the AIOL of FIG. 25A. [Figure 26] FIG. 26 shows a model of an AIOL similar to that of FIG. 25A, but modified. [Figure 27] FIG. 27 shows a model of the adjustability of the AIOL of FIG. [Figure 28A] FIG. 28A shows a cross-sectional perspective view of another AIOL, according to many embodiments. [Figure 28B] FIG. 28B shows a model of the adjustability of the AIOL of FIG. 28A. [Figure 29] FIG. 29 shows a cross-sectional perspective view of yet another AIOL, according to many embodiments. [Diagram 30] FIG. 30 shows a lens associated with the AIOL of FIG. [Diagram 31] FIG. 31 illustrates another AIOL adjustability model, according to many embodiments. [Diagram 32] FIG. 32 illustrates yet another model of AIOL adjustability, according to many embodiments. [Diagram 33] FIG. 33 shows a schematic diagram of the adjustability of an AIOL, according to many embodiments. [Figure 34A] FIG. 34A illustrates an AIOL, according to many embodiments. [Figure 34B]FIG. 34B shows the internal pressure of the AIOL chamber as in FIG. 34A. [Figure 35A] FIG. 35A illustrates an AIOL, according to many embodiments. [Figure 35B] FIG. 35B shows the internal pressure of the AIOL chamber as in FIG. 35A. [Diagram 36] FIG. 36 illustrates a method of manufacturing an AIOL, according to many embodiments. [Figure 37] FIG. 37 shows an optical structure that has been modified to provide optical power. [Figure 38A] FIG. 38A shows an AIOL with a forward-most portion of the AIOL forward of the forward-most portion of the haptics, where the deflectable members of the AIOL are configured to deflect in response to translational and rotational movement of the haptics, according to many embodiments. [Figure 38B] FIG. 38B shows the internal chamber pressure as a function of load for an AIOL such as that in FIG. 38A. [Figure 39A] FIG. 39A shows a perspective view of an intraocular lens, according to an embodiment. [Figure 39B] FIG. 39B shows a cross-sectional view of the intraocular lens of FIG. 39A, according to an embodiment. [Figure 40A] FIG. 40A shows a perspective view of an intraocular lens, according to an embodiment. [Figure 40B] FIG. 40B shows a cross-sectional view of the intraocular lens of FIG. 40A, according to an embodiment. [Figure 41A] FIG. 41A shows a cross-sectional view of an accommodating intraocular lens, according to an embodiment. [Figure 41B] FIG. 41B shows a perspective view of the lens components of the intraocular lens of FIG. 41A. [Figure 41C] FIG. 41C shows a perspective view of the opposing lens components of the intraocular lens of FIG. 41A. [Diagram 42] FIG. 42 shows a cross-sectional view of an intraocular lens, according to an embodiment. [Diagram 43] FIG. 43 shows a cross-sectional view of a fluid-filled accommodative lens system with a bellows structure, according to an embodiment. [Diagram 44]FIG. 44 shows a cross-sectional view of an alternative accommodating lens system, according to an embodiment. [Diagram 45] FIG. 45 shows a cross-sectional view of an alternative fluid-filled accommodating lens system, according to an embodiment. [Figure 46A] FIG. 46A illustrates assembly of an alternative AIOL comprising four main parts, according to an embodiment. [Figure 46B] 46B and 46C illustrate assembly of an alternative AIOL comprising four major parts, according to an embodiment. [Figure 46C] 46B and 46C illustrate assembly of an alternative AIOL comprising four major parts, according to an embodiment. [Figure 47] FIG. 47 shows the complete assembly as embodied in FIGS. 46A to 46C. [Figure 48] 48A-48C illustrate an alternative AIOL comprising three main parts, according to an embodiment. [Figure 49] 49A and 49B illustrate another AIOL comprising three main parts, according to an embodiment. [Figure 50] FIG. 50 shows an alternative AIOL lens system with multiple square-shaped annular area edges. [Figure 51] 51A-51C illustrate an embodiment incorporating a toric lens with indexing features and capsular rotation inhibition. [Figure 52] 52A-52C illustrate an alternative embodiment incorporating a toric lens with indexing features and capsular rotation inhibition. [Figure 53] FIG. 53 shows an AIOL properly positioned within a delivery device with capsular rotation restraints. [Figure 54] 54A through 54C depict an alternative embodiment with an intermediate bellows stabilization feature. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0121] The accommodating intraocular lenses (AIOLs) described herein are used to provide improved vision and can be combined with one or more of many known surgical procedures and devices, such as cataract surgery and intraocular lens inserters. The optical structure of the AIOL is highly suitable for use with commercially available IOL power formulas based on ocular biometry and can be used to provide improved vision. In many embodiments, a physician can insert the AIOLs described herein in a manner similar to a conventional non-accommodating IOL, such that a physician can easily use the AIOLs described herein.

[0122] The structure of the AIOL described herein can be combined in one or more of many ways to provide an improved accommodating IOL. In many embodiments, the AIOL comprises an optical structure constructed of a flexible material, which is coupled to haptics to provide optical power using the natural forces of the eye's lens capsule, for example, as described herein. In many embodiments, the deflectable member has sufficient radial strength such that a radially inward force against an outer portion of the deflectable member results in deflection of an inner portion of the deflectable member. The deflection can include, for example, a primary reversible buckling of the deflectable member. In many embodiments, the deflectable member bends such that the inner portion has a convex curvature along the outer surface and the outer portion has an opposite convex curvature along the outer surface. The convex inner portion can have a disk shape and the outer concave portion can have an annular shape adjacent to the disk shape. The arrangement of the convex disk shape and the concave annular shape can provide, for example, two inflection points across the diameter of the deflectable member.

[0123] The radially extending deflectable members can be configured in one or more of a number of ways to provide radial strength to deflect at least the inner portion, for example, by one or more of elastic modulus, thickness, or diameter.

[0124] The deflectable members can be coupled to the haptics in one or more of a number of ways to deflect when urged radially inward by haptics engaging the capsule. In many embodiments, the deflectable members have sufficient radial strength to induce a change in shape of at least the inner portion when the outer portion of the deflectable member is urged radially inward or rotated or a combination thereof. In many embodiments, the deflectable members are coupled to the capsule such that rotation of the haptics relative to the rigid member induces radially inward movement and rotational deflection of the outer portion of the deflectable member. Alternatively, or in combination, the haptics can be arranged to slide radially and relative to the rigid member to urge the deflectable member inward with a radial force and deflect the inner portion of the deflectable member with the radial strength of the outer portion. The deflectable member may include one or more structures on the outer portion to facilitate deflection, such as, for example, a concave outer portion or a thin annular region to facilitate concave deflection of the outer portion and convex deflection of the inner portion.

[0125] The present disclosure relates to devices, methods, and systems related to improved accommodating intraocular lenses (AIOLs). Some embodiments will comprise a central optical structure composed of two deformable lenses spaced apart along their optical axes, such as by a lens support structure concentric with the optical axis of the lenses. The volume bounded by the lenses and optionally the lens support structure can be filled with an ionic solution, such as saline, or a non-ionic solution, such as dextran or silicone oil. At the same time, the optical structure may be bounded by one or more haptic structures, which are either filled with a fluid or, in another embodiment, are disposed in a plane perpendicular to the optical axis of the lens. The haptic structures can be in fluid communication with the fluid bounded by the optical structure. The movement of fluid between the haptic structures and the fluid-filled optical structure can change the accommodative power of the lens by deforming one or both lenses. Alternatively, or in combination, the haptic structures may directly apply a mechanical force to the lenses of the fluid-filled optical structure to effect deformation and change the accommodative power. The improved accommodating intraocular lens system may further include any combination of the features described herein.

[0126] Some of the lenses and support structures described herein will typically be made from hydrophilic materials that are optically clear when hydrated, expand by more than 10% when hydrated, and accommodate distortion levels of more than 100% when hydrated. The materials can be purchased as small disks and rods. For example, the hydrophilic material can include copolymers of hydroxyethyl methacrylate (HEMA) and methyl methacrylate (MMA), such as CI18, CI21, or CI26 manufactured by Contamac Ltd. (UK). Additionally, any of the intraocular lens systems shown and described herein may be manufactured by Benz The optics may be made of Benz IOL 25 UVX™ material manufactured by Benz Research and Development (Sarasota, Florida). These materials are also referred to herein as PMMA, and as used herein, PMMA refers to a polymer that includes PMMA, or a copolymer that includes PMMA, such as one or more of PMMA polymer (hereinafter "poly(methyl methacrylate)") or a copolymer of HEMA and PMMA, such as, for example, p(HEMA-co-MMA). As used herein, p(HEMA-co-MMA) refers to a copolymer of HEMA and PMMA, which may also be referred to as p(HEMA-MMA).

[0127] The copolymer may include, for example, one or more of a block copolymer (PPPP-HHHH), an alternating copolymer (PHPHPHPH), a statistical or random copolymer (PHPPHPHH), a star copolymer, a brush copolymer, or a graft copolymer, where, for example, "P" indicates "MMA" and "H" indicates "HEMA."

[0128] In some embodiments, components of the hydrogel AIOL may be fabricated by 3D printing, including, but not limited to, any of the following common 3D printing processes: stereolithography (SLA), inkjet material jetting (IMJ), digital light processing (DLP), selective laser sintering (SLS), fused deposition modeling, or fused filament fabrication (FDM / FFF). Methods such as SLA, IMJ, and DLP may be particularly suitable for fabricating AIOL elements comprised of hydrogels, such as PMMA, and copolymers, such as HEMA. In such embodiments, the starting materials may be monomeric or oligomeric precursors of the hydrogel polymer, or combinations thereof. One such polymer useful in the fabrication of the AIOLs described herein may include pHEMA, where the polymerization reaction is photoinitiated by a UV source of appropriate wavelength and duration. In some such embodiments, photoinitiation may be further enhanced by the addition of a photoinitiator compound mixed with the monomers used for printing. Such photoinitiators may release additional free radicals upon illumination, thereby increasing the rate of the polymerization reaction. A selection of photoinitiators are listed below.

[0129] In some embodiments, a complete AIOL can be fabricated by a 3D printing process and removing the unpolymerized material inside the structure after completion of the build. Alternatively, or in combination, the unpolymerized material within the lens structure can be treated to render the reactive end groups non-reactive so that further polymerization of the material cannot occur. In other embodiments, the AIOL structure can be fabricated as a subcomponent for later assembly as described elsewhere herein to machined parts.

[0130] As used herein, a positive curvature of the outer surface encompasses a convex curvature, and a negative curvature of the outer surface encompasses a concave curvature.

[0131] As used herein, similar reference numbers refer to similar structures. In many embodiments described herein, the reference numbers are made up of three or four digits, with the first one or two digits referring to the figure number and the last two digits referring to similar structures in the figures with different numbers. For example, reference numbers 2503 and 3303 refer to similar deflectable members in Figures 25 and 33, respectively. Those skilled in the art will recognize that text describing a structure in one drawing applies to similar structures in any other figures provided herein.

[0132] In many embodiments, the deflectable member comprises an inner optic portion and an outer extension portion to concentrate and amplify the optical power within the inner optic portion. The inner optic portion can be moved away from the rigid member to include a convexly curved outer surface that provides increased optical power. In addition, the outer portion can be deflected and moved toward the rigid member to include an opposite curvature. The oppositely curved outer portion can reduce the diameter of the optical correction portion to concentrate the optical power change within the inner portion. The optical power of the inner portion is related to the increase in the distance of the center of the inner portion from the rigid member and the decrease in the distance from the outer extension portion to the rigid member. Such a combined effect of the increase in the distance of the inner separation and the decrease in the distance of the outer separation have a combined effect in increasing the optical power. Also, when the optical power of the lens can be reduced approximately as the square of the diameter of the lens, the reduced diameter of the inner portion provided by the oppositely curved outer portion can further increase the optical power of the lens.

[0133] In some embodiments, the intraocular lens / lens system and / or other components defining the lens chamber or fluidic optical element are filled with an aqueous, transparent fluid having a higher refractive index than water to increase the optical power of the system. The high refractive index of the lens chamber liquid may result from the presence of solutes. Such solutes often include large molecules that cannot traverse the chamber defining the components. Examples of such large molecules include dextrans, with exemplary molecular weights of <40 kD, <70 kD, <500 kD, and <1000 kD. Further examples of such solutes include sugar molecules. The solutes and water may constitute a dilute solution having an osmotic pressure. Such osmotic pressure may move water in or out of the chamber to achieve an osmotic equilibrium volume. Such volume may be sufficient to produce an appropriate optical power in the system to the strength desired for the patient.

[0134] Each of the accommodating IOLs described herein comprises an anterior side and a posterior side. The nodal point of the lens is preferably located along the optical axis of the lens at a midpoint located along the optical axis approximately equidistant from the anterior and posterior surfaces of the optical structure of the lens. In many embodiments, the nodal point of the lens is located away from a plane extending between the peripheral haptic lever structures to define the anterior to posterior orientation of the lens. The anterior to posterior orientation of the lens can be reversed by one skilled in the art based on the teachings disclosed herein.

[0135] The flexible material of the AIOL's optical structure may be shaped in one or more of a number of ways, including, for example, machined or molded components, and combinations thereof.

[0136] The improved accommodating intraocular lens may have a reduced delivery cross-section. The reduced delivery cross-section may be facilitated by an optical structure that can be transformed from a delivery configuration to an operational configuration. The optical structure may have a smaller dimension along the optical axis in the delivery configuration and a larger dimension along the optical axis in the operational configuration. Also, the lens support structure may be configured to maintain the distance between the outer edges of the two lenses in the operational configuration and to allow fluid to pass between the haptic structure and the fluid volume bounded by the optical structure in either configuration.

[0137] The delivery cross section may be achieved by folding or rolling the AIOL around a delivery axis perpendicular to the optical axis. The delivery cross section may be measured as the maximum dimension in the delivery configuration measured in a plane perpendicular to the delivery axis. The delivery cross section achievable for the AIOLs disclosed herein may be less than 4.5 mm, preferably less than 2.5 mm. In an alternative embodiment, the delivery cross section may be achieved by forcing the AIOL through a tube or delivery opening. Such a tube may be conical in cross section so that the AIOL may be compressed as it advances down the tube. The distal end may be sized to contact the incision in the eye. Delivery may be facilitated by a syringe or plunger.

[0138] The intraocular lens system may be comprised of at least two hydrophilic PMMA lenses, where PMMA represents a compound that includes, for example, one or more of polymethyl methacrylate (PMMA), polyhydroxyethyl methacrylate (PHEMA), hydroxyethyl methacrylate (HEMA), or methyl methacrylate (MMA). The lens system may include other elements comprised of any of the following materials, among others: NiTi, polyurethane, hydrophilic PMMA, photoactivated polymers, precursors of PMMA, ethylene glycol dimethyl acrylate (EGDMA), silicone, silicone copolymers, or any combination thereof.

[0139] One or more of the generally planar or plano-convex members may comprise a polymeric material. The polymeric material may include materials available, for example, from Contamac Ltd. (UK) or Vista Optics Ltd. (UK). For example, PMMA copolymers include Definitive 50 material, Definitive 65 material, Definitive 74 material, Filcon V3 material, Filcon V4 material, Filcon V5 material, Optimum Classic material, Optimum Comfort material, Optimum Extra material, Optimum Extra 16 material, Optimum Extra 18.25mm material, Optimum Extra 19mm material, Optimum Extra 21mm material, Optimum Extreme material, F2 material, F2 Low material, F2 Mid material, F2 High material, Focon III 2 material, Focon III 3 material, Focon III 4 material, Hybrid FS material, Contaflex GM Advance material, Contaflex GM Advance 49% material, Contaflex GM Advance 58% material, Filcon I 2 material, Filcon II 2 material, Contaflex GM3 49% material, Contaflex GM3 58% material, Contaflex material, Contaflex 58% Material, Contaflex 67% Material, Contaflex 75% Material, Polymacon 38% Material, Hefilcon 45% Material, Methafilcon 55% Material, Filcon II Material, Filcon IV 2 Material, HI56 Material, PMMA Material, CI26 Material, CI26Y Material, CI18 Material, and Contamac Ltd.(UK) as well as other variations available from Vistaflex GL 59 material, HEMA / GMA material, Advantage+49 material, Advantage+59 material, Filcon I 1 material, Filcon 12 material, VSO nVP material, nVP / MMA material, VSO 60 material, VSO 68 material, VSO 75 material, Filcon II 1 material, Filcon II 2 material, VSO pHEMA material, pHEMA material, HEMA material, VSO 38 material, VSO 42 material, VSO 50 material, Vistaflex 67 Clear UV material, Polysiloxy-acrylate material, AddVALUE Silicone Acrylate material, AddVALUE 18 material, AddVALUE 35 material, Polyfluoro-Silicone-Acrylate material, AddVALUE Fluorescent Silicone Acrylate material, AddVALUE 25 material, AddVALUE 50 material, AddVALUE 75 material, AddVALUE 100 material, scleral rigid gas permeable material, hydrophobic intraocular lens material, VOPhobic Clear Tg. The polymeric material may be selected from a list including 16 material, VOPhobic Yellow Tg 16 material, hydrophilic intraocular lens material, HEMA-MMA copolymer material, IOSoft material, IOSoft clear material, IOSoft yellow material, PMMA material, Vistacryl CQ UV material, Vistacryl XL blue material, Vistacryl CQ material, and other variations available from Vista Optics Ltd. (UK). In many cases, the polymeric material may be one or more of water permeable and hydrophilic. Water present in the capsular bag of the patient's eye may migrate into or out of the fluidic optical element through the polymeric material to achieve osmotic equilibrium with fluid present in the capsular bag when the intraocular lens is placed therein. The polymeric material may be impermeable to silicone oil. The polymeric material may be impermeable to compounds having a molecular weight of greater than 40 kDa.

[0140] In some embodiments, the AIOL is inserted into and connects to the natural capsule such that the interface area creates a seal that forms a semi-annular region of the capsule, where fluid movement between the semi-annular region and the interior of the AIOL results in a change in accommodation of the AIOL. In such embodiments, a fluid, such as saline, can be injected into the semi-annular region.

[0141] In some embodiments, the optical structure is comprised of a material that is changed from a delivery configuration to an operational configuration after being introduced into the capsule of the eye. One such material may include a photoactive polymer that is liquid in the delivery configuration, which is hardened by light activation after introduction. Another such material may include a memory metal, such as a NiTi alloy, that has a thin dimension in a plane perpendicular to the optical axis in the delivery configuration, and that is initiated to change to the operational configuration after introduction by heating via inductive coupling. In other embodiments, NiTi may rely on its superelastic properties to transition from the delivery configuration to the operational configuration.

[0142] In some embodiments, the optical structure is mechanically more stable in the working configuration than in the delivery configuration, and naturally changes from the delivery configuration to the working configuration after introduction into the capsule of the eye. In such a configuration, the optical structure may be placed in the delivery configuration immediately before delivery or at the time of manufacture. One such system may include a superelastic metal element that pops out of the delivery configuration when the device is introduced into the capsule.

[0143] In some embodiments, the lens support structure and one lens are machined or molded as a unitary structure, and the second lens is secured to the support structure by a bonding means. In many other embodiments, the AIOL is constructed of two halves, each incorporating a lens that are bonded together to form the optical structure. Such embodiments may incorporate haptic structures. In still other embodiments, a second machining operation may be performed on the bonded structure. Alternative bonding means may include mechanical connections, such as threads, threading the outer edge of the lens and threading the inner surface of the support structure. In alternative embodiments, the connection may be a simple interference fit. In some embodiments, the fixing includes bonding the materials by treating one or both of the separate bonding surfaces with a precursor monomer, then assembling the structure, applying a load across the bonding surfaces, and heating the assembly for a period of time. Such a process may facilitate crosslinking between the materials comprising both parts. In some cases, the precursor monomer may be mixed with small particles of a polymer. The bonding agent may further include urethane, silicone, epoxy, acrylic, among others.

[0144] In the devices of the present disclosure, the lens may be composed of a water and ion permeable material. In some embodiments, the AIOL may be self-hydrating after implantation, thereby minimizing the delivery cross section.

[0145] In an alternative embodiment, the AIOL is filled after implantation.

[0146] FIG. 1 illustrates an accommodative intraocular lens (AIOL) system or intraocular lens 10 comprised of a central lens support structure 11, two haptics 12, two deflectable lenses 13, only one of which is shown in FIG. 1, and two compression bands 14. The haptics 12 are configured to deform under minimal load and may comprise a thin-walled structure comprised of an elastic material. The interior volume of the AIOL 10 may be filled with a clear fluid, such as saline, at an osmolality equivalent to the ocular fluid surrounding the capsular bag. Alternatively, the AIOL 10 may be filled with a high refractive index fluid as described elsewhere herein. The lenses 13 are connected to the support structure 11 such that as fluid moves from the haptics into the interior volume of the support structure, the lenses are deflected, thereby changing their accommodative power.

[0147] A side view of the lens support structure 11 of FIG. 1 is illustrated in FIG. 2 with two lenses 13. The lenses 13 may be of the same shape or may have different shapes. The haptic structure contact surface feature 15 included in the lens support structure 11 is also illustrated in FIG. 2. The open end of the haptic structure 12 fits over the haptic structure contact surface feature 15 and is further secured to the lens support structure contact surface feature 15 using a compression band 14. Additionally, in some embodiments, an adhesive or sealant such as silicone may be used. In alternative embodiments, a pressure fit may be used. In still other embodiments, the haptics 12 may be molded onto the haptic contact surface. In one embodiment, the haptics 12 are molded onto PMMA barbs that are subsequently bonded to the support structure 11. The bond is made by adhesive or by facilitating cross-linking between the barbs and the support structure as described herein below. The haptics 12 and the material for connecting the haptics may include any or any combination of silicone, PEBAX, urethane, copolymers of PMMA and silicone, and other elastic materials. The distance between the outer edges of the lens 13 may be maintained by the support structure 11 while the center of the lens is allowed to deflect as the fluid volume increases within the support structure 11, thereby changing the accommodative power of the structure. In some embodiments, the haptic structure 12 may be made by extrusion.

[0148] Figure 3 illustrates a lens support structure 31 in which one of two lenses, a first lens 36, is contained within or integral with the support structure 31. In the embodiment of Figure 3, a second lens, lens 33, is configured to be connected to the support structure 31 via threads 37. Structure 35 extends outwardly to connect the lens body to the haptics.

[0149] Another embodiment of a central support structure similar to that shown in FIG. 3 is illustrated in FIG. 4. In this embodiment, a second lens 43 is connected via an interference fit. In some embodiments, the interference fit can be further sealed through the use of a sealant or adhesive. The interference fit is further facilitated by the procedure used to assemble and rehydrate the components. One such procedure performed on the support structure 41 shown in FIG. 4 is as follows: the bottom of the support structure 41 with the lens 46 is hydrated, then the unhydrated lens 43 is fitted into a groove included in the support structure 41, the support structure 41 and the lenses 43 and 46 are fully hydrated, and then a sealant or adhesive is applied, if necessary. The use of an interference fit can minimize the need and / or amount of bonding agent.

[0150] 5 illustrates another embodiment of an AIOL 50 in which half of the support structure 51 and haptic structure 52 are included in the top and bottom halves of the AIOL 50, such that the entire is made from the same material. The two halves are joined together at seam 59 to form the complete haptic and support structure 51. Lenses 53 may either be integral with the half structure or bonded to the support structure 51. In a manufacturing environment, aligning one lens and bonding after the remainder of the structure is fabricated can provide the advantage of ensuring that the optical axes of the two lenses are precisely aligned.

[0151] In the embodiment shown in Figures 1 and 2, the haptic structures 12 extend in a plane perpendicular to the optical axis of the lens and are configured in such a way that they can be folded away from the support structure 11. Such a configuration can facilitate a reduction in the delivery cross-section of a fluid-filled device. In the embodiment shown in Figures 6 and 7, the haptic structures are integral with the lens support structure and are continuously attached around the periphery of the lens support structure.

[0152] 6 illustrates an embodiment of an AIOL 60, where haptics 62 and support structure 61 are integral and configured as a ring-like structure. That is, the inner diameter of the ring-like structure includes support structure 61. Fluid may be allowed to flow between haptics 62 and the interior volume of support structure 61 through openings 67. AIOL 60 can be made by joining two halves at seam 69. Lens 63 may be integral with one half or separately joined to the other half.

[0153] A variation of the embodiment of FIG. 6 is illustrated in FIG. 7. The embodiment of AIOL 70 incorporates features that help reduce the delivery cross-section. The halves of the support structure may be included in the top and bottom halves of AIOL 70, respectively, and may be comprised of a series of structures 71 separated by spaces forming castellated rings. The castellated structures may be interlocked during assembly before being joined at seam 79. A spring ring 79' may fit into a groove and lock the top and bottom halves of the structure against displacement along the optical axis. As shown in FIG. 7, lens 73 may be integral with the half structure including AIOL 70. In other embodiments, lens 73 may be separated and joined at another time. In such an embodiment, the support structure may deform more during delivery because the castellated elements may fold with a larger radius of curvature. AIOL 70 may also include feature 78, which may enable a means of applying pressure directly across seam 79 during the joining process. The surfaces including the seams may further incorporate chamfers or bevels to direct the flow of the bonding agent and minimize the possibility of creating voids.

[0154] 8 depicts an embodiment of an AIOL 80 comprising a resilient support structure 81 filled with a fluid that can be cured after delivery of the AIOL. Such fluids may be optically cured and may include, for example, UV-cured silicones or epoxies, pH-cured fluids such as collagen solutions, or thermally cured fluids, where the material includes a suspension of particles that can be inductively heated, such as magnetite particles. Channels 87 can allow fluid to pass between the haptics and the central volume of the support structure.

[0155] In an alternative embodiment, the support structure 81 of the AIOL 80 can be replaced with a support structure 91 with a channel structure 97, as shown in the expanded configuration of the AIOL 80 shown in Figure 9A, or by a support structure 98 shown in Figures 9B and 9C, which can be made of a memory metal that is flattened to have a flattened configuration 99 shown in Figure 9B before assembly, and later heated by inductive coupling that can assume an operating configuration after delivery, as shown in Figure 9C. Such a configuration can result in a reduced cross section.

[0156] The embodiments described herein also allow for a sequence of assembly and the use of extended cure, heat, pressure, and / or optically initiated bonding materials to ensure proper optical alignment of the lenses.

[0157] Bonding of HEMA and MMA copolymers may be facilitated by treating the bonding surfaces with EGDMA or triethylene glycol dimethyl acrylate (TEGDMA) and then exposing the bonded surfaces to pressure and temperature. Treatments may include, but are not limited to, steam treatment, wetting, wetting and evaporating, applying a mixture of particles of EGDMA or TEGDMA and a copolymer of hydroxyethyl methacrylate and methyl methacrylate. In one such procedure, 40 micron beads of HEMA and MMA copolymer may be mixed with EGDMA and used as a bonding agent. Such a bonding scheme may provide advantages in that there are no or minimal seams and the mechanical properties of the bonded connection have the same mechanical properties as the structure.

[0158] Delivery procedures may vary and will depend on the embodiment of the device. In one delivery procedure for an AIOL, which is typically pre-filled with a working fluid at the time of manufacture and ready to use, the device may be selected to a size and baseline accommodation strength that matches the patient's needs. The eye is prepared according to standard procedures, typical for instillation of a non-accommodating lens, with possible exceptions in some embodiments where the incision may be large. The AIOL is loaded into an injector and then injected into the prepared eye's pouch. The AIOL may then be adjusted in position. In an alternative delivery procedure, the lens may be filled at the time of surgery. In such a procedure, filling may include sizing the AIOL and setting the baseline strength of the AIOL. To accommodate such procedures, the device may incorporate a filling port that may be sealable by bonding prior to implantation, or a port that includes a self-sealing material, such as an elastic material.

[0159] In yet a further alternative, the AIOL is filled after implantation, thereby minimizing the delivery cross-section. In such an embodiment, after implantation, the device may be filled through a fill port as described above. In an alternative embodiment, the device may be initially in a fully non-hydrated state and may be fully hydrated after implantation, such as by self-filling with the eye's naturally available fluids. For example, the AIOL may include materials in a fully non-hydrated state, such as fluid elements within the AIOL, which may be fully hydrated with fluids from the eye, preventing leakage from the AIOL during the hydration process. Such an embodiment may depend on the water permeability of materials and small molecules contained in the AIOL. In such a procedure, a device that is appropriately sized and filled with an appropriate working fluid, typically a saline solution having an osmolality and ionic balance comparable to the fluids naturally occurring in the eye, is prepared for implantation by exposure to a hypertonic solution of large molecules, such as a solution of ultra-high molecular weight dextran. This pretreatment may draw fluid out of the AIOL prior to implantation, thereby reducing its delivery cross-section. The AIOL may then be implanted through an incision in the eye. After implantation, the AIOL can remove fluid from the eye and restore its fluid and optical equilibrium. In some embodiments, the osmotic pressure of the AIOL can be further adjusted by incorporating molecules that are too large to diffuse through the material that comprises the AIOL at the time of manufacture. In such a system, the equilibrium filling pressure of the AIOL can be adjusted or set at the time of filling.

[0160] 10 shows an AIOL with an alternative haptic structure in which a fluid chamber is formed by sealing the equatorial region 1002 of the capsule at locations 1004 and 1005. The equatorial chamber 1002 can communicate with a posterior chamber 1006 by holes 1007 in the structure of the AIOL. Movement of the ciliary body causes fluid in chamber 1002 to pass in and out of chamber 1006, deflecting the single optic 1003 and providing accommodation.

[0161] The chambers 1002 and 1006 may be filled either naturally, such as with an aqueous fluid, or with other fluids, such as saline, and a viscous, cohesive fluid may be used to prevent leakage at the contact locations 1004 and 1005.

[0162] Various methods to improve the seal may be employed at locations 1004 and 1005: glue may be applied to the capsule as a binder, a fibrosis mechanism may be induced, sharp protrusions may be provided at the contact points to increase the seal against the capsule by indenting it, an anterior contact location 1005 may be provided having a means to capture the edge of the capsulotomy 1001.

[0163] The optical element 1003 may be provided with hinge means along the edges of the optical area to allow for deflection and displacement and therefore increased optical power.

[0164] The assembly may have an outer envelope of near crystalline dimensions, thus minimizing the possibility of capsule shrinkage.

[0165] The lack of traditional haptics may pose fewer sizing issues, but the only relevant capsule dimension may be its height.

[0166] The system may be insensitive to differences in aqueous humor osmolarity.

[0167] To reduce the possibility of leakage, there may be an adjustment geometry in the dimensions as cut.

[0168] 11 illustrates an alternative AIOL incorporating a two optic lens system with haptic structures configured to form a fluid chamber by sealing against the equatorial and posterior regions of the capsular bag, according to many embodiments. An additional posterior optic 1101 defines a fluid optic or fluid chamber 1102 and may be provided for optical reasons (e.g., to establish a fluid chamber 1102 and provide improved optical accommodation).

[0169] FIG. 12 shows an alternative AIOL that incorporates two optical elements with haptic structures configured to form a fluid chamber by sealing against the equatorial and posterior regions of the lens capsule, according to many embodiments, and a thin film 1201 can be attached to the structure to contain the fluid.

[0170] FIG. 13 shows an alternative AIOL having haptic structures configured to form fluid chambers by sealing the equatorial and posterior regions of a lens capsule incorporating one optical element, according to many embodiments, where a thin film 1301 can be attached to the structure to contain fluid for implementation of a single optical element.

[0171] 14A and 14B illustrate an alternative AIOL in which a single optic lens support structure 1401 opens circumferentially uniformly around the circumference of the device, according to many embodiments, and the lens support structure is not connected to fluid-filled or other conventional haptics. The AIOL device is shown in FIGS. 14A and 14B as resting in a capsular bag receiving structure or chamber 1405, with the lens support structure 1401 contacting the posterior capsule at 1402 and also contacting the anterior capsule at 1403. The device can be positioned such that the anterior capsule opening 1404 and the lens support structure 1401 can align with the capsulorhexis 1001 in a manner that affects the operative mechanical seal described below. FIG. 14B illustrates an installed AIOL after surgery, where the capsule conforms to the installed device and provides the seal required to create chambers 1405 and 1406 for activation and relaxation of the lens accommodation. The AIOL can be inserted into and contact the natural capsule such that the attachment area seals against the semi-annular region of the capsule. Fluid movement between the semi-annular region and the interior of the AIOL can result in accommodative changes in the AIOL, such as deflection of the lens surface 1407.

[0172] Figure 15-23B illustrates alternative AIOL embodiments with emphasis on their fabrication. Figure 15 shows an optical subassembly composed of a front lens element 1501 and a rear lens element 1502. An optical fluidic channel 1503 allows fluid to enter the fluidic optical element or optical chamber 1504, and the subassembly is coupled to a lens support structure 1601 with mounting holes 1505.

[0173] 16A and 16B show the optical subassembly of FIG. 15 insert molded into lens support structure 1601, with contact points 1602 and 1603 bonded together at 1604 to complete the assembly of the AIOL.

[0174] FIG. 17 shows a modified embodiment of that previously described in FIG. 16 incorporating a posterior opacifying cell dam 1701 and a capsulotomy support flange 1702.

[0175] Figure 18 illustrates the final assembly of an AIOL in which the optical subassembly 1806 is insert molded into a lens support structure 1805 and the haptic structure 1801 is bonded to 1805 at points 1802 and 1803 to create a haptic fluid chamber 1804. This configuration may alternatively incorporate a lens such as the lens illustrated in Figure 19 in which the optical assembly 1901 is bonded to the support structure 1903 at insert posts 1902 using either solvent or heat. The lens system of Figure 19 is sealed after assembly by hydrating the lens system until it expands by approximately 10%, thereby providing a fluid-tight pressure fit.

[0176] 20 is a top view of an AIOL incorporating the optical assembly shown in FIG. 19, etc. Insertion and attachment points 2001 are shown. Accommodation can occur when the fluid channels 2002 allow movement of fluid into the central fluidic optical element or lens chamber as the haptic structures 2003 are compressed by the equatorial circumference of the lens capsule (not shown). The relief 2004 of the haptics allows for minimal circumferential stress during compression and rapid recovery to the unaccommodated position when compression is relieved.

[0177] Figure 21A is a side cross-sectional view of the AIOL of Figure 20 showing the point of minimum deformation 2101 in the haptic structure, and Figure 21B shows the deformation of the haptic structure when a physiologically relevant load is applied to the haptic structure. Figure 22 is an isometric view of the AIOL assembly of Figures 20, 21A, and 21B.

[0178] Figure 23A is an alternative embodiment and method of assembly where lens system 2302 is insert molded into haptic structure enclosure 2303. Figure 23B shows the completed AIOL assembly with central fluidic optical element or lens chamber 2304, with sealed haptic seams 2307 creating haptic chamber 2308.

[0179] FIG. 24 shows an alternative low profile AIOL with alternative haptic and support structures comprised of an optical structure described herein, a rear haptic structure 2406, and a front haptic structure 2407. The optical structures may be aligned and secured via attachment to posts 2441, which may be joined at points 2401. Haptic seams 2442 at the outer edge 2402 of the AIOL may be joined to form a seal and create the haptic fluid reservoir 2404. In such an embodiment, the join at points 2401 and the haptic seams 2442 may form a fluid-tight seal to prevent fluid from leaking into and / or out of the haptic fluid reservoir 2404. The central optical structure may comprise a front planar member 2403, which may be deflectable, and a rear plano-convex portion 2410, which may be resistant to deflection.

[0180] The embodiments described herein can be combined in one or more of many ways, for example, the embodiments of Figures 25A-28B and 31-35B can be combined to include similar or alternative structures, and combinations thereof, described herein, where the last two digits of the figure identification numbers indicate similar structures.

[0181] FIG. 25A shows a model of the accommodability of an AIOL similar to FIG. 24. The AIOL has a non-deflected configuration 2521 for distance vision and a deflected configuration 2522 for near vision. The AIOL is shown in a non-accommodated configuration with a planar configuration of anterior planar deflectable member 2503 coupled to lever haptic structure 2502. The outer structure of haptic portion 2502 is configured to engage the lens capsule and may have a structure for reducing pressure against the capsule as described herein. The rigid member 2510 may comprise a lens for providing an optical power for distance vision. The deflectable member 2503 may comprise, for example, a generally planar member having a substantially constant thickness. The deflectable member 2503 comprises an inner optic portion and an outer peripheral extension. The extension extends between the inner optic portion and the rotating haptic structure 2502. When the inner optic portion has a convex deflection, the fluid in the chamber below the inner optic portion is shaped to provide an optical correction.

[0182] The deflectable member 2503 and the rigid member 2510 define at least a portion of an interior chamber 2512. The interior chamber 2512 contains a fluid having a refractive index greater than the refractive index of the aqueous humor of the eye. When the deflectable member 2503 has an increased curvature, the interior fluid has a convex lens shape, providing additional optical power.

[0183] The AIOL has a central thickness that extends from the outer surface of the rigid member 2510 to the outer surface of the deflectable member 2503. The central thickness may have a first central thickness 2530 for the AIOL lens in the distance configuration and a second central thickness 2531 for the AIOL lens in the near configuration. An increase in the central lens thickness is related to an increase in the optical power of the lens. The increase in the optical power of the lens is also approximately inversely related to the square of the diameter of the central optic. The extension portion may reduce the diameter of the optic and provide an increase in optical power for an amount of change from the first distance 2530 to the second distance 2531.

[0184] The rigid member 2510 is connected to the haptic structure 2502 so that the haptic structure 2502 rotates when the lens is adjusted for near vision. The haptic structure 2502 extends to a first fixation region, such as a fixed point (similar to the fixed point 2640 shown in FIG. 26) about which the haptic rotates relative to the rigid member 2510. The haptic structure extends a distance from the first fixation region to the wall of the capsule. The haptic structure 2502 extends to a second fixation region, such as a second fixation region or point (similar to the fixed region or point 2641 shown in FIG. 26). The second fixation region is coupled to the deflectable member 2503 to induce an inward force on the deflectable member. The distance from the first region to the outer structure of the haptic that engages the capsule is greater than the distance from the first region to the second region. This difference in distance provides mechanical leverage of the capsule force on the deflectable member 2503. The capsule force against the deflectable member 2502 induces a convex deflection 2524 of the deflectable membrane. Extension 2511 has an opposite concave curvature.

[0185] The extension portion may have an opposing concave curvature, but this curvature may be provided in one or more of a number of ways to reduce visual disturbances. The amount of accommodative optical correction may be about 2-10 diopters, such that the opposing curvature of the extension portion may not result in a perceptible optical effect for the patient. Also, the eye naturally has spherical aberration, and small amounts of aberration may not be perceptible. Furthermore, the lens may be sized to cover at least a portion of the concave portion where the pupil is oppositely curved. In at least some embodiments, the thickness profile of the extension portion of the deflectable component may be thin to concentrate the opposing curvature in a thinner outer portion of the deflectable member. Although curved deflectable members may be provided and configured to inhibit visual disturbances related to internal reflections, studies on embodiments suggest that a substantially planar deflectable member reduces visual disturbances that may occur due to, for example, internal reflections.

[0186] In many embodiments, the haptics portion 2502 comprises an outer reservoir coupled to the chamber 2512, and the force of the haptics portion on the outer reservoir can be added to the inward force of the haptics portion 2502 at the fixed point 2541, for example, to urge fluid towards the chamber 2512 as the eye accommodates.

[0187] The AIOLs described herein can be studied using finite element modeling. Finite element modeling can be done in one or more of many ways, but in many embodiments, the finite element modeling is done using known, commercially available software, such as Abaqus, known to those skilled in the art. The lenses described herein can be modeled using a finite element mesh and known material properties of one or more of the materials described herein, and the response of the AIOL to capsular forces can be determined.

[0188] One skilled in the art can take the finite element modeling output of the lenses described herein and determine, for example, the optical power of the AIOL as a function of capsular bag forces to determine appropriate AIOL parameters for providing accommodation to the eye. At least Figures 25A-28B and 31-35B show the response of an AIOL to capsular bag forces, according to embodiments.

[0189] FIG. 25B shows a cross-sectional view of the model from which FIG. 25A was developed. Note that the lens or optics structure 2505 has additional space between the individual lenses, and the rear haptic structure 2506 and the front haptic structure 2507 incorporate additional mating surfaces 2508. In such an embodiment, the haptic structures 2506, 2507 may be overmolded onto the lens or optics structure 2503. The haptic structures 2506, 2507 may be constructed of a thermoplastic or solvent weldable material, thereby facilitating bonding of the two halves. The features that comprise the mating surfaces 2508 may also include fluid passages 2509 or positioning and alignment features (not shown) shown in FIG. 25C.

[0190] In the AIOL embodiment of Figures 25A-25C, the deflection of the deflectable structure or lens 2503 may be driven primarily by mechanical forces applied to the peripheral edges of the haptic structure 2502 that are transmitted to the deflectable structure or lens 2503 by a middle portion of the haptic structure 2502. The deflectable structure or lens 2503 may be clipped as shown, since the deflectable structure or lens 2503 does not rest directly on the non-deflectable lens 2510. In such an embodiment, the deflection experienced by the deflectable lens or structure 2503 increases the accommodation force of the fluidic optical element or lens created between the deflectable structure or lens 2503 and the non-deflectable structure or lens 2510, and the volume of the fluidic optical element will increase as the accommodation force increases. Thus, additional optical fluid is required and may be brought from a reservoir contained in the haptic structure 2502 via channel 2509.

[0191] FIG. 26 depicts a variation of the AIOL of FIGS. 25A-C, where the anterior haptic structure 2602 is stiffened with a haptic structure wall 2606 to improve the force couple to the deflectable structure 2603. Forces coming from the equatorial region of the capsular structure of the eye are coupled through the outer edge of the haptic structure 2602, creating a moment about the bending point 2611. The moment results in an outward deflection of the deflectable structure 2603. The AIOL of FIG. 26 may include elements similar to those of FIGS. 25A-C, such as a stiffening member 2610, an inner chamber 2612, a deflection configuration 2622, a convex deflection 2624, an inner optic portion 2625, a first central thickness 2630, a second central thickness 2631, a fixing point 2640, a fixing point or region 2641, etc.

[0192] FIG. 27 is a representation of the adjustability of an AIOL 2700 similar to that of FIG. 24. The AIOL includes a deflectable structure or anterior lens 2703, a rigid or non-deflectable member 2710, and a haptic structure 2702 supporting the deflectable structure 2703 and the rigid member 2710. When placed on an eye, the deflectable member 2703 can be located at an anterior portion of the AIOL and the rigid member 2710 can be located at a posterior portion of the AIOL. In this embodiment, the haptic wall 2706 of the haptic structure 2702 is coupled to a haptic reservoir 2707 that is in fluid communication (e.g., through a fluid channel) with a fluid lens structure of the internal chamber 2712 of the AIOL. Deflection of the deflectable member 2703 of the optical structure can be caused at least in part by fluid pressure created by deflection of the haptic structure 2702 and the haptic wall 2706. For example, the outer edge of the haptic structure 2702 can rotate due to a force applied to the outer edge of the haptic structure 2702 (e.g., an inward force of a capsule structure), simultaneously causing an inward collapse in the haptic reservoir 2707, thereby increasing the pressure in the haptic reservoir 2707 and displacing fluid therefrom into the fluid lens structure 2712. The increase in volume of the fluid lens structure 2712 can move the deflectable member 2703 forward relative to the rigid member 2710, thereby increasing the curvature and increasing the optical power of the eye. In some embodiments, the rotation of the haptic structure 2702 can move the deflectable structure 2703 and the rigid member 2710 together further in the opposite direction of the rotation relative to the haptic structure 2702 to increase the optical power of the eye. The AIOL 2700 can further include elements similar to those of the AIOLs described in Figures 25A-25C and 26. For example, the AIOL 2700 may further include a bending point 2711, a deflection configuration 2722, a convex deflection 2724, an inner optical portion 2725, a first central thickness 2730, a second central thickness 2731, a fixed point 2720, and a fixed point or region 2741.

[0193] 28A and 28B illustrate variations of the AIOL of FIGS. 25 and 26. FIG. 28A shows a half cross section of the AIOL. The AIOL is composed of an optical or lens structure 2805, which in turn is composed of a deflectable structure or member 2803, a rigid or non-deflectable lens or member 2810, and a fluid-filled lens chamber or fluidic optical element 2812. The optical or lens structure 2805 can be held together by a haptic structure 2802. The haptic structure 2802 can have alignment structures 2816 that allow the elements of the AIOL to be stacked during assembly. The alignment structures 2816 can also include alignment posts 2822 and diaphragm elements 2826. Other elements include a spacer 2814 and a cover seal 2815. The materials from which the haptic structure 2802 is composed are typically solvent and / or heat weldable. The spacer element 2814 comprises a channel that facilitates fluid communication between the fluid-filled lens chamber 2812 and the haptic reservoir 2813 comprising the diaphragm 2826. The fluid-filled lens chamber 2812 and the haptic reservoir 2813 may form a closed system, such as a sealed reservoir. In this embodiment, the haptic reservoir 2813 is not deformed as by actuation forces applied to the outer edge of the haptic structure 2802. The diaphragm element 2826 may be isolated from receiving direct forces transmitted from the capsular structure of the eye, and instead deflects in accommodating pressure changes within the fluid-filled lens chamber or the fluidic optical element 2812. The diaphragm element 2826 may be fluidly coupled to the fluid-filled lens chamber 2812 such that a forward deflection of the diaphragm element 2826 shown in FIG. 28B corresponds to an increase in the volume of the fluid-filled lens chamber 2812 and a rearward deflection of the deflectable structure 2803. Such an embodiment may have advantages when it is desirable to use only forces generated at the equatorial region of the capsule to mediate accommodation. In such an embodiment, the pressure in the inner lens chamber may be negative.The AIOL of Figures 28A and 28B may further include elements similar to those of the AIOLs described in Figures 25A to 25C, 26, and 27, such as bending point 2811, non-deflecting configurations 2821, 2821, convex deflection 2824, inner optical portion 2825, first central thickness 2830, second central thickness 2831, fixed point 2820, fixed point or region 2841, etc.

[0194] In many of the embodiments described above, such as those of Figures 24 through 28B, the AIOL will be assembled when all of its components are in a dry state. If the optic or lens structure is constructed from a hydrophilic PMMA copolymer, the system will be hydrated upon completion of assembly. When hydrated, the hydrophilic lens components expand, thereby enhancing the sealing of the chambers within the structure.

[0195] FIG. 29 shows an embodiment of an AIOL, where the lens or optical structure is made by overmolding a lens 2910 into each of the two halves 2906 and 2907 of the AIOL. As shown, the lenses are the same. However, in some embodiments, it may be desirable for them to be different, such as when one lens is deflectable and the other is not. The haptic structure 2902 with the haptic fluid chamber 2913 can be made during assembly by folding a peripheral element of the structure 2906 and bonding it to the bonding surface 2903. In this embodiment, the seam 2908 may be left unbonded, such as at location 2909. In such an embodiment, when pressure is applied to the outer surface of the haptic structure 2902, the lens 2910 will be displaced and deflected. Such a structure may provide advantages by minimizing the delivery cross section, since the top and bottom halves can invaginate into one another when the structure is compressed.

[0196] FIG. 30 illustrates a lens structure from the AIOL of FIG. 29 that incorporates pit features 2920 that facilitate fixation of components of the haptic structure 2902 when the lens is overmolded into either half of the AIOL structure.

[0197] FIG. 31 illustrates an embodiment of an AIOL 3100 comprising a concave region 3111, a rigid or non-deflectable member 3110, and a deflectable member 3103 comprising a fluid-filled chamber 3112. In this embodiment, the concave surface of the concave member 3111 causes an inward deflection of a central portion of the concave region 3111 relative to the rigid or non-deflectable member and an outward deflection of the deflectable member 3103 relative to the rigid or non-deflectable member into a convex configuration. In many embodiments, when the AIOL 3100 is placed in the capsular bag, the inward deflection of the concave region 3111 is in an anterior direction and the outward deflection of the central portion of the concave member 3111 is in a posterior direction, or vice versa in alternative embodiments. In many embodiments, the concave region 3111 has a uniform thickness. The AIOL 3100 may further include elements similar to those of the AIOLs described above (Figures 25A to 25C, 26, 27, 28A to 28B, etc.), such as an internal chamber 3112, a deflection configuration 3122, a convex deflection 3124, an internal optical portion 3125, a first central thickness 3130, a second central thickness 3131, a fixing point 3140, a fixing point or region 3141, etc.

[0198] 32 shows an embodiment of an AIOL 3200 comprising a deflectable member 3203 with a concave region 3211, a rigid or non-deflectable member 3210, a fluid-filled lens chamber 3212, and a haptic structure 3221 having walls. In this embodiment, the concave surface of the concave member 3211 translates the rotation of the haptics and haptic structure walls 3221 relative to the rigid member 3210 into an outward deflection of the deflectable member 3203 relative to the rigid member 3210, such that the center of the deflectable member 3203 separates from the rigid member 3210 as the outer portions of the deflectable member move towards the rigid member. In many embodiments, when the AIOL 3200 is placed in the capsular bag, the inward deflection of the concave region 3211 is in the anterior direction and the outward deflection of the central portion of the concave member 3211 is in the posterior direction, and vice versa in alternative embodiments. In many embodiments, the recessed region 3211 thins the remainder of the deflectable member 3203 to act as a hinge. For example, the recessed region 3211 may include a concave cutout in an outer surface region of the deflectable member 3203. The AIOL 3200 may further include elements similar to those of the AIOLs described above (e.g., FIGS. 25A-C, 26, 27, 28A-B, 31, etc.), such as a deflection configuration 3222, a convex deflection 3224, an inner optic portion 3225, a first central thickness 3230, a second central thickness 3231, a fixing point 3240, a fixing point or region 3241, etc.

[0199] 33 shows a schematic diagram of an AIOL in a non-deflectable configuration 3321 and a deflectable configuration 3322. The AIOL comprises a rigid or non-deflectable member 3310 (e.g., another convexly curved optical surface), a deflectable member 3303 (e.g., an optical material with a uniform and constant thickness to prevent distortion) that can be deflected to a deflectable configuration 3325, a fluid-filled chamber 3312, and a lever or cantilever haptic structure 3302. The lever structure haptic portion 3302 is connected to the rigid member 3310 at a first fixed point 3340 or region, such as a thinned portion near the outer edge of the rigid member 3310. The first fixed point 3340 or region may be any point or region along an axis extending through the outer edge of the rigid member 3310 and the outer periphery of the lever structure haptic portion 3302. When the AIOL is placed in the capsular bag of the eye, the periphery of the haptics 3302 of the lever structure may extend in a direction transverse to or perpendicular to the optical axis of the eye. The haptics 3302 of the lever structure is also connected to the deflectable member 3303 through the elastic extension 3311 at the second fixed point 3341 or region. In many embodiments, the elastic extension 3311 has a thickness less than the thickness of the deflectable member 3303. In these embodiments, the haptics 3302 of the lever structure has a length greater than the thickness and thickness. The length of the haptics 3302 of the lever structure may be greater than the distance between the first fixed point 3340 and the second fixed point 3341 such that mechanical leverage (e.g., inward force from the capsular bag or ocular pressure) can be applied to the second fixed point 3341 from the end of the haptics 3302 of the lever structure that contacts the capsular bag of the eye.

[0200] In many embodiments, rotation of the lever structure haptics 3302 about the first fixed point 3340 of the rigid member 3310 can apply a force to the elastic extension 3311 to deflect the elastic extension 3311 and the deflectable member 3303 in opposite directions with opposite curvatures. For example, the rotation may move the elastic extension 3311 closer to the rigid member 3310 having a concave outer surface and separate the deflectable member 3303 further away from the rigid member 3310 having a convex outer surface. The deflection of the deflectable member 3303 may involve a transition from a first diameter D1 to a second diameter D2, the second diameter D2 being smaller than the first diameter D1. The reduction in size of the diameter can cause a convex deflection 3324, such as a spherical deflection, of the deflectable member 3303 away from the rigid member 3310. In the deflectable configuration 3322, the convex deflection 3324 of the deflectable member 3303 can be characterized by a curvature, and the elastic extension 3311 can be characterized by an opposite curvature. The curvature of the convex deflection 3324 can be the opposite of the curvature of the elastic extension 3311. For example, the curvature of the convex deflection 3324 can be a positive curvature along the outer surface of the AIOL, and the curvature of the extension can have a negative curvature along the outer surface of the AIOL.

[0201] A change in diameter of the deflectable member 3303 from D1 to D2 may result in a corresponding amplified movement away from the rigid member 3310 such that the deflection height between the first height 3330 and the second height 3331 is greater than the corresponding change in diameter. In such an embodiment, the positive curvature of the spherical deflection may cause the fluid filled chamber 3312 to assume a more convexly curved profile to change the optical power of the AIOL. The change in shape of the fluid filled chamber 3312 may result in an increase in volume, thereby drawing fluid into the fluid filled chamber 3312 from a peripheral reservoir or the like. Alternatively, or in combination, the change in shape of the deflectable member 3303 and the fluid chamber 3312 may occur without substantially changing the volume of the chamber 3312. For example, the change in shape of the fluid filled chamber 3312 may change the optical power by, for example, drawing fluid from an outer portion of the chamber 3312 and by redistribution of the internal fluid without drawing fluid from a peripheral reservoir. Rotation of the haptics 3302 of the lever structure may also translate the deflectable member 3303 and the rigid member 3310 together in an anterior direction relative to the outer edge of the haptics 3302 of the lever structure when the AIOL is placed in the capsular bag. Such translation may further change the optical power of the eye. The combination of separating the deflectable member 3303 from the rigid member 3310, deflecting the deflectable member 3303 to increase its curvature, and translating the deflectable member 3303 and the rigid member 3310 together in an anterior direction may change the optical power of the eye. For example, this combination may amplify a small contraction in the capsular bag housing the AIOL into a noticeable change in the optical power of the AIOL. Such a change in optical power may be significantly greater than any one of the separation, deflection, and translation actions alone.

[0202] The haptic structures described herein may include silicone, urethane, or other suitable thermoplastics, PMMA, and PMMA copolymers. In many embodiments, the haptic structures include the same or similar materials as the optical structures.

[0203] 34A shows an AIOL, according to an embodiment. The undeflected configuration 3421 is shown in dashed lines and the deflected configuration 3422 is shown in solid lines, as described herein. The AIOL comprises an inner optic portion 3425 and an extension, as described herein. Similar structures are shown herein, indicated with similar last two digits.

[0204] Figure 34B shows the internal pressure of the AIOL chamber as in Figure 34A. The pressure in the internal chamber 3412 is shown to increase with load. This increased pressure with load indicates that both the inward force of the lever haptic structure and the internal pressure of the AIOL are due to the convex deflection 3424 of the internal optical structure 3425.

[0205] The AIOL of Figures 34A and 34B may further include elements similar to those of the AIOLs described above (Figures 25A to 25C, 26, 27, 28A and 28B, 31, 32, etc.), such as haptic structures 3402, deflectable structures or front lenses 3403, rigid members 3410, bending points 3411, first central thickness 3430, second central thickness 3431, fixed points 3440, fixed points or regions 3441, etc.

[0206] 35A shows an AIOL, according to an embodiment. The undeflected configuration 3521 is shown in dashed lines and the deflected configuration 3522 is shown in solid lines, as described herein. The AIOL comprises an inner optic portion 3525 and an extension, as described herein. Similar structures are shown herein, indicated with similar last two digits.

[0207] FIG. 35B shows the internal pressure of the AIOL chamber as in FIG. 35A. The pressure in the inner chamber 3512 is shown to decrease with load. This reduction in pressure with load indicates that the inward force of the lever haptic structure can result in a convex deflection 3524 of the inner optical structure 3525. Furthermore, when the pressure is negative, this pressure response curve shows that the deflection and change in optical power is the result of a mechanically driven radially inward load as opposed to from pressure from a fluid in the chamber. FIG. 35B shows that the inward force of the lever haptic structure can deflect the deflectable member 3503 due to negative pressure in the inner chamber.

[0208] The AIOL of Figures 35A and 35B may further include elements similar to those of the AIOLs described above (Figures 25A to 25C, 26, 27, 28A and 28B, 31, 32, 34A and 34B, etc.), such as haptic structure 3502, deflectable structure or front lens 3503, rigid member 3510, bending point 3511, internal chamber 3512, convex deflection 3512, first central thickness 3530, second central thickness 3531, fixed point 3540, fixed point or region 3541, etc. join

[0209] Bonding can be used to adhere one or more of the many AIOL structures disclosed herein. The structures can be bonded in one or more of the many ways described herein, and the steps, processes, and materials can be combined to provide improved bonding of the AIOL structures.

[0210] The combination of components described herein can be used, for example, with one or more of the many IOL components, with one or more of the many IOL materials, with accommodative and non-accommodative IOLs, and with one or more of the many AIOLs described herein. The accommodative IOL can include one or more haptics for connecting the disk-shaped component to the capsular bag to change the optical power of the lens in response to deformation of the capsular bag. In many embodiments, the one or more haptics include a chamber that is fluidly connected to a chamber that includes the first and second lens components. The haptics can be made of a flexible material described herein, such as, for example, an acrylate polymer, or a silicone polymer, or a combination thereof.

[0211] Although reference is made to rigid, machined polymer bonds, the bonds disclosed herein can be used with, for example, one or more of hydrated polymers, flexible hydrated polymers, machined polymers, molded polymers, molded dry polymers, molded rigid polymers, molded flexible polymers, or molded hydrated polymers, and combinations thereof.

[0212] In many embodiments, the AIOL comprises a first component and a second component. The first component comprises a first disk-shaped structure and the second component comprises a second disk-shaped structure. The annular structure extends between the first disk-shaped structure and the second disk-shaped structure and defines a chamber containing a fluid having a refractive index greater than about 1.336, which is the refractive index of aqueous humor of the eye. When the curvature of one or more of the first disk structure or the second disk structure increases, the optical power of the AIOL increases.

[0213] The first and second components can be bonded together at one or more bonding surfaces. The location of the bonding surfaces can be selected to reduce the effect of the bonding surfaces on the optical properties of the AIOL. For example, the bonding surfaces can extend circumferentially around one or more of the annular structure, the first disc-shaped component, the second disc-shaped component, and combinations thereof. In many embodiments, the bonding surfaces are located at or near a seam that extends circumferentially around one or more of the annular structure, the first disc-shaped component, the second disc-shaped component, and combinations thereof that bond the components together. Locating the seam away from the optical portions of the first and second components results in improved optical properties.

[0214] In many embodiments, the first and second components are machined on a lathe to provide a rotationally symmetric structure, such as a first disk-shaped structure and a second disk-shaped structure. One or more of the first or second components may have an annular structure prior to bonding the components together. One or more annular grooves may be provided on the first and second components to optically align the first component with the second component. One or more portions of the annular groove or a groove or grooves of other shapes may be used as a bonding surface for bonding the first and second components together.

[0215] Various techniques can be used to bond the first and second components together. For example, direct bonding methods can be used to join the bonding surfaces described herein. Direct bonding methods can advantageously provide a continuous bonding interface that has similar material and mechanical properties to the rest of the structure. For example, the bonding interface can expand similarly to the first and second components of the structure. Exemplary direct bonding methods can include thermal bonding, solvent bonding, local welding, or surface modification.

[0216] Thermal bonding of a first and second component can involve heating the components (e.g., at or near the bonding surfaces) to a temperature near or above the glass transition temperature of one or both of the components. During the heating process, pressure can be applied to increase the contact force between the components at the bonding surfaces. By using suitable temperature and pressure conditions, the polymer chains of the components can be caused to interdiffuse and entangle with each other between the bonding surfaces, thereby bonding the first and second components together.

[0217] Solvent bonding can involve applying a suitable solvent to the bonding surfaces of the first and second components. The solvent solvates the polymer chains of the components at the bonding surfaces, thereby increasing the mobility of the chains and allowing them to interdiffuse between the bonding surfaces. For example, solvent bonding of components made from copolymers of HEMA and MMA can be facilitated by treating the bonding surfaces with a suitable solvent. Exemplary solvents can include EGDMA, diethylene glycol dimethacrylate (DEGDMA), triethylene glycol dimethylacrylate (TEGDMA), water, methanol, ethanol, acetone, dimethylsulfoxide, acetonitrile, isopropanol, n-hexanol, ethylene dichloride, methylene dichloride, cyclohexane, or suitable combinations thereof. The bonding surfaces can be washed and then wetted with a solvent. The bonding surfaces can be bonded by contacting each other and exposing them to suitable pressure and temperature conditions (e.g., using a press, oven, heated plate, etc.) for a predetermined length of time.

[0218] Localized welding can involve the focused application of energy at or near the bonding surfaces to heat and soften the bonding surfaces, thereby bonding the components together. Suitable forms of energy can include ultrasonic, microwave, or infrared energy. In some examples, suitable components can be formed on one or more of the components to direct the applied energy to appropriate areas of the bonding surfaces.

[0219] As another example, suitable surface modification techniques can be applied to one or more of the bonding surfaces described herein to achieve direct bonding. Surface modification involves treating the bonding surface to increase its surface energy, thus improving surface contact and increasing the degree of polymer chain entanglement between the bonding surfaces. In many embodiments, the bonding surfaces can be modified by plasma activation, UV exposure, and / or ozone exposure. The parameters of the surface modification treatments described herein (e.g., treatment time) can be selected to optimize the degree of surface rearrangement of the polymer chains of the bonding surfaces.

[0220] Alternatively, or in addition, direct bonding techniques utilizing a suitable adhesive can be used to bond the first and second components of the AIOL. The adhesive can be applied to at least a portion of the bonding surfaces described herein. In many embodiments, the adhesive is selected to have similar material and mechanical properties as the first and second components. For example, the adhesive can include a prepolymer of a polymer of the components. The prepolymer can include, for example, one or more of a monomer, oligomer, partially cured monomer, particle, or nanoparticle of the polymer. Such bonding embodiments can provide the advantage of no or reduced seams, i.e., the bonding interface has similar mechanical properties as the structure. For example, the adhesive can expand similarly to the first and second components. This can be beneficial when the adhesive is provided circumferentially around the first and second components as described above, since such components can expand, for example, substantially along the diameter and circumference. Reduced stress along the bonding surfaces of the AIOL can be beneficial because the AIOL can be made small to reduce insertion size and can include a thin, deformable structure configured to deform with reduced stress.

[0221] In many embodiments, the adhesive (e.g., prepolymer) is cured to bond the first and second components together. The curing process may involve polymerizing one or more components of the adhesive using techniques known to those skilled in the art. For example, the precursor monomers of the prepolymer may be partially or fully polymerized by the addition of an initiator. The initiator may be, for example, a photoinitiator such as Irgacure 651 (I651, Ciba-Geigy), or a radical initiator such as 2,2'-azobis(isobutyronitrile), 2,2'-azobis(2,4-dimethylvaleronitrile), dilauroyl peroxide, or bis(4-t-butylcyclohexyl) peroxydicarbonate. In many embodiments, the monomers are polymerized in the presence of a crosslinker. The crosslinker may include one or more of EGDMA, DEGDMA, or TEGDMA. Polymerization of the monomers and crosslinker may form an interpenetrating polymer network (IPN) that may be entangled with the first and second components, thereby bonding them together. In some cases, the bonding surface can be activated using a suitable activating agent to provide exposed reactive groups, thereby allowing the formation of chemical bonds between the bonding surface and the prepolymer and / or crosslinker. After the polymerization process, excess reagents can be removed by rinsing, immersion in a suitable solvent, or other methods known to those skilled in the art.

[0222] The bonding techniques described herein can be applied at any point during the fabrication of the AIOLs described herein. For example, the first and second components can be bonded together while in a rigid, substantially dry configuration. Each of the components can be provided in a rigid configuration for machining and bonded together with an adhesive while in the rigid configuration. The components can be substantially hydrated. Alternatively, the components can be bonded while in a partially or fully hydrated configuration.

[0223] In many embodiments, the first and second lens components include a copolymer of hydroxyethyl methacrylate and methyl methacrylate. When cured, the adhesive includes a copolymer of hydroxyethyl methacrylate and methyl methacrylate. This configuration can allow the lens to expand from a rigid, not fully hydrated configuration to a fully hydrated configuration that substantially expands and prevents stress on the components and where the adhesive is located along the seam. Those skilled in the art will appreciate that the rigid, not fully hydrated configuration of the polymeric material includes a polymer having a low enough amount of moisture to provide rigidity to the polymeric material of the first and second components. The not fully hydrated configuration can include a substantially dry configuration consisting of about 5% moisture or less, e.g., 0.2-3% moisture, such that the polymeric material has sufficient rigidity to machine the material to optical tolerances, as will be readily understood by those skilled in the art. For example, when the AIOL is placed in the capsular bag or placed in a hydration buffer, the polymer can expand to a hydrated state and gradually expand to a fully hydrated state, as will be readily understood by those skilled in the art. A fully hydrated polymer may consist of, for example, about 15% to 30% water, depending on the material selected. A fully hydrated polymer may swell by more than 10%, such as 10% to 15%.

[0224] FIG. 36 illustrates a method 3600 of manufacturing and providing an AIOL.

[0225] A mass of polymeric material as described herein is provided at step 3610. The mass of material is chopped into a first component 3612 and a second component 3614. The polymeric material has a rigid configuration as described herein.

[0226] In step 3620, the first component 3612 and the second component 3614 are shaped into the first lens component 3622 and the second lens component 3624 of the AIOL. The components can be shaped by one or more of many methods, such as machining on a lathe, cutting, abrasion, or other known methods of shaping an optical lens. Alternatively, or in combination, the components can be molded. One or more of the components 3622, 3624 can have features 3626 shaped to receive the opposing component (the features 3626 can have, for example, an annular groove). A channel 3628 can be provided to enable fluid communication with the chamber 3636 of the AIOL. Alternatively, or in combination, the channel 3628 can be formed when the first and second components are joined together.

[0227] In step 3630, the first component 3622 and the second component 3624 are joined together with an adhesive 3632 provided at the feature 3626. The first component 3622 and the second component 3624 define the chamber 3636.

[0228] The adhesive 3632 includes a prepolymer of the polymers of the components 3612 and 3614. Although components provided from a single mass are shown, the polymeric material can be provided in masses of separate materials having a similar polymer composition.

[0229] The haptic 3638 can be fixed to the AIOL 3635 such that the internal chamber of the IOL is fluidly connected to the chamber of the haptic. The haptic can include a material similar to or different from that of the AIOL. The haptic 3638 can have a thickness 3639. For example, the AIOL can include acrylate as described herein, and the haptic 3638 can include a flexible silicone material. The haptic can include a flexible material inserted within the AIOL if the AIOL has, for example, a rigid configuration.

[0230] The AIOL in its rigid configuration includes a transverse dimension 3634, such as a diameter. The AIOL can have a thickness 3648 extending between a forward-most portion of the AIOL body and a rearward-most portion of the AIOL body.

[0231] In step 3640, the AIOL 3635 is hydrated to a substantially hydrated configuration to reduce stiffness such that the AIOL has a pliable material. In the hydrated configuration, the dimensions of the AIOL increase and may increase proportionally to one another. In many embodiments, this increase has a similar percentage increase along each dimension.

[0232] In many embodiments, the amount of hydration in the rigid configuration has a predetermined amount of hydration in order to precisely machine the lens components to the appropriate amount of optical power when the AIOL is fully hydrated when implanted in the eye.

[0233] The disk-shaped optical structures of the upper component 3622 may be, for example, flat or lenticular. The disk-shaped optical structures of the lower component 3624 may be, for example, flat or lenticular, such that one or more of the optical structures deform to provide optical power.

[0234] 37 shows an optical structure modified with a deflected surface profile to provide optical power with a curved spherical surface profile 3700, as described herein. To increase the optical power with the curved surface 3700, the fluid of the AIOL may be greater than the refractive index of aqueous humor, 1.33. The optical component 3624 may have a generally planar shape that does not provide significant optical power in a first configuration, and may be modified into the deflected curved spherical surface profile 3700 that provides optical power for accommodation.

[0235] Although acrylates are referenced, the polymers and prepolymers may include silicone hydrogel materials, for example.

[0236] 38A shows an AIOL with its anterior-most portion forward of the anterior-most portions of the haptics (both shown lower on the page), and the deflectable members of the AIOL are configured to deflect in response to translational and rotational movement of the haptics. In alternative embodiments, the lenses can be installed in opposed anterior-posterior orientations, as described herein. The deflectable members 3803 comprise sufficient radial strength such that a radially inward force against an outer portion of the deflectable member results in deflection of an inner portion of the deflectable member, as described herein.

[0237] The deflectable members can be configured in one or more of a number of ways to provide radial strength, for example, to deflect at least the inner portion by one or more of elastic modulus, thickness, or diameter.

[0238] The deflectable member can be coupled to the haptics in one or more of many ways to deflect when urged radially inward by the haptics engaging the capsule. In many embodiments, the deflectable member has sufficient radial strength to induce a change in shape of at least the inner portion when the outer portion of the deflectable member is urged radially inward or rotated, and combinations thereof. In many embodiments, the deflectable member is coupled to the capsule such that rotation of the haptics relative to the rigid member moves the outer portion of the deflectable member radially inward to induce rotational deflection. Alternatively, or in combination, the haptics can be arranged to slide radially and relative to the rigid member such that a radial force urges the deflectable member inward and the radial strength of the outer portion deflects the inner portion of the deflectable member. The deflectable member may include one or more structures at the outer portion to facilitate deflection, such as, for example, a concave outer portion or a thin annular region that facilitates concave deflection at the outer portion and convex deflection at the inner portion.

[0239] The AIOL has a non-deflected configuration 3821 for distance vision and a deflected configuration 3822 for near vision. The AIOL is shown in a non-accommodated configuration with a planar configuration of anterior planar deflectable member 3803 coupled to lever haptic structure 3802. The outer structure of haptic portion 3802 is configured to engage the lens capsule and may include structure for reducing pressure against the capsule, as described herein. The rigid member 3810 may include a lens that provides an optical power for distance vision. The deflectable member 3803 may include, for example, a substantially planar member having a substantially constant thickness. The deflectable member 3803 includes an inner optic portion 3825 and an extension 3811. The extension 3811 extends between the inner optic portion 3825 and the translation and rotation haptic structure 3802. When the inner optic portion 3825 includes a convex bias 3824, the fluid in the chamber below the inner optic portion is shaped to provide optical correction for near vision.

[0240] The deflectable member 3803 and the rigid member 3810 define at least a portion of an interior chamber 3812, as described herein.

[0241] The AIOL has a central thickness extending from the outer surface of the rigid member 3810 to the outer surface of the deflectable member 3803. The central thickness may comprise a first central thickness 3830 of the lens in the distance configuration and a second central thickness 3831 of the lens in the near configuration. An increase in the thickness of the lens at the center is associated with an increase in the optical power of the lens. The increase in the optical power of the lens is also approximately inversely proportional to the square of the diameter of the central optic. An extension portion may reduce the diameter of the optic and provide an increase in optical power for a change from the first distance 3830 to the second distance 3831.

[0242] The rigid member 3810 is connected to the haptic structure 3802 such that the haptic structure 3802 rotates as the lens adjusts for near vision. The haptic structure 3802 extends to a first fixation region, such as a fixation point 3840, about which the haptic translates and rotates relative to the rigid member 3810. The haptic structure extends a distance from the first fixation region to the wall of the capsule. The haptic structure 3802 extends to a second fixation region, such as a second fixation point 3841. The second fixation region 3841 is coupled to the deflectable member 3803 to induce an inward force on the deflectable member. The distance from the first region to the outer structure of the haptic that engages the capsule is greater than the distance from the first region to the second region. In at least some embodiments, this difference in distance allows the deflectable member 3803 to provide at least some mechanical leverage of the capsule force. The radial force of the capsular bag on the deflectable member 3803 induces a convex deflection 3824 of the deflectable member. The extension 3811 includes an opposing concave curvature.

[0243] Components of an AIOL, such as the rigid member, the deflectable member, and one or more haptics, may comprise the same polymer, as described herein. These components may have different amounts of flexibility and stiffness, for example, depending on their thickness. In many embodiments, the haptics have a thickness to at least partially reversibly deform when the deflectable members are urged radially inward by one or more of rotation or translation in response to a radially inward force of the capsular bag.

[0244] FIG. 38B shows the internal chamber pressure as a function of load on the AIOL as in FIG. 38A. The internal pressure of the AIOL increases approximately linearly with the load on the AIOL. The internal pressure and the radially inward force together can deflect members 3803 to provide optical power as the eye accommodates, as described herein. The modeled loads are normalized with respect to one or more published maximum load values ​​that correspond to the force of the capsular bag on the AIOL, which can be readily determined by one of ordinary skill in the art based on published data. The material properties of the AIOL modeled herein can be readily determined based on published data for the materials described herein.

[0245] FIG. 39A shows an accommodating intraocular lens 3900. The intraocular lens 3900 may comprise a central lens region 3904 and a peripheral bellows region 3903 with two bellows 3903a and 3903b. The intraocular lens 3900 may be manufactured in two components, a top half 3900a and a bottom half 3900b. The materials used may be compatible, such as hydrophilic acrylic or hydrogel. Other materials may be used alternatively or in combination. The two halves 3900a and 3900b may be assembled as shown in FIG. 39B by gluing the top half 3900a to the bottom half 3900b at the joint 3901. The cavity 3905 between the two halves 3900a and 3900b may be filled with a high refractive index fluid, causing the intraocular lens 3900 to function as a lens.

[0246] The function of the double bellows feature 3903 may be to increase the responsiveness of the intraocular lens 3900. The outermost 3903c of the bellows 3903 may interact with the capsular bag of the eye. When the bag exerts pressure on the bellows 3903, fluid may be displaced from the bellows region 3903 into the central lens cavity. The increased pressure may cause the upper lens portion 3900a to deform upwards and change its radius of curvature, thus producing strength changes and accommodation. The innermost bellows 3903a may be adapted such that its outermost wall may be very compliant. Any pressure exerted from the innermost wall of the outermost bellows 3903b may be translated into fluid displacement from the innermost bellows 3903a cavity. In this way, even with the increased stiffness due to the bond lines along the outermost bellows 3903, deformation may still be able to occur in the innermost bellows 3903a.

[0247] A row of individual protrusions, or projections 3902 may be constructed on the inner surface 3906b of the bottom half 3900b, or alternatively, the inner surface 3906a of the top half 3900a, as shown in Figure 39B. The projections 3902 may function to maintain a gap between the two halves, thereby facilitating fabrication.

[0248] Any of the features of the intraocular lens 3900 may be combined with any of the features of the other intraocular lenses described herein, and vice versa.

[0249] 40A and 40B show an accommodating intraocular lens 4000. The intraocular lens 4000 may comprise a central lens region 4004 and a peripheral bellows region 4003. The intraocular lens 4000 may be manufactured in two components, a top half 4000a and a bottom half 4000b. The materials used may be compatible, for example, hydrophilic acrylic or hydrogel. Other materials may be used alternatively or in combination. The two halves 4000a and 4000b may be assembled as shown in FIG. 40B by gluing the top half 4000a to the bottom half 4000b at the junction 4001. The cavity 4005 between the two halves 4000a and 4000b may be filled with a high refractive index fluid, causing the intraocular lens 4000 to function as a lens.

[0250] A series of individual paddles 4002 may be constructed along the outermost wall of the bellows 4003. When the capsule exerts pressure on the paddles 4002, the paddles 4002 may transfer a force to the outermost wall of the bellows 4003, causing the wall to deform radially inward. In this manner, fluid may be displaced from the bellows region 4003 into the central lens cavity 4005. The paddles 4002 may not be continuous along the circumferential outer edge of the intraocular lens 4000 as shown in FIG. 40A to reduce the circumferential, and therefore radial, stiffness of the assembly or lens 4000.

[0251] The displaced fluid may cause an increase in pressure that may deform the top lens portion 4000a upward, changing its radius of curvature, resulting in strength changes and accommodation. Similar to intraocular lens 3900, a row of individual protrusions or projections may be constructed on the inner surface 4006b of bottom half 4000b, or alternatively, the inner surface 4006a of top half 4000a, as shown in FIG. 39B. The projections may function to maintain a gap between the two halves 4000a, 4000b, thereby facilitating fabrication.

[0252] Any of the features of the intraocular lens 4000 may be combined with any of the features of the other intraocular lenses described herein, and vice versa.

[0253] 41A shows an accommodating intraocular lens 4100. An optical axis 4140 extends through a central lens region 4104. The intraocular lens 4100 may, for example, comprise a central lens region 4104 and a peripheral bellows region 4103 having two bellows. An annular shaped rigid coupling structure may extend circumferentially around the central lens region 4104 including the optical axis. The annular shaped rigid coupling structure may comprise a first annular shaped rigid coupling structure 4107a located on the first component and a second annular shaped rigid coupling structure 4107b located on the second component.

[0254] The two bellows may comprise a continuous inner bellows 4103a and a continuous outer bellows 4103b in fluid communication with each other. In many embodiments, the bellows may comprise one or more folds. The bellows fold has the advantage that the resistance against the capsule is reduced as the capsule biases inward, and the bellows can move radially outward as the capsule expands. The folds may also provide a very gentle outward force against the capsule, improving coupling with the capsule. Those skilled in the art may use biometrics such as optical coherence tomography to size the bellows region to the capsule. The bellows region 4103 may comprise a first fold 4108a on the first component and a second fold 4108b on the second component. The first fold 4108a and the second fold 4108b may extend inward and toward each other in a direction similar to the optical axis. The first and second folds can be continuous and extend circumferentially around the optical axis, for example, 360 degrees around the optical axis. This arrangement of folds can provide coupling of the lens to the capsular bag with deflection of the folds.

[0255] The bellows region can be configured in many ways, with one or more folds that allow an external reservoir to couple to the internal chamber. Although two circumferentially extending bellows are shown with folds extending therebetween, a different number of bellows may be provided, for example, three or more bellows. The bellows 4103a and 4103b may be continuous along the outer edge of the central lens region 4104. The bellows 4103a and 4103b may be annular, elliptical, or rotationally symmetric in shape. Fluid may reside within the continuous internal volume of the bellows 4103a and 4103b. The internal bellows 4103a may be in fluid communication with the central lens region 4104.

[0256] The rigid coupling structure can be configured in many ways to inhibit radially inward movement or force from the bellows region to the central lens region 4104 when the capsule biases against the bellows region, displacing fluid from the bellows region into the central lens region 4104. The rigid coupling structure similarly inhibits radially outward movement of the central lens region 4104 when the bellows region moves radially outward in response to a reduction in capsule force. The first annular shaped rigid coupling structure 4107a can include a first radial thickness greater than a first thickness of the first bellows region 4103a, and the second annular shaped structure 4107b can include a second radial thickness greater than a second thickness of the second bellows region 4103b. The rigid connecting structure may be relatively rigid compared to other structures of the lens, such as folding, but the rigid connecting structure may be configured to be one or more of rolled, folded, or compressed, for example, for insertion through a small incision in the eye. The intraocular lens 4100 may be manufactured in many ways, for example, using one or more of turning to form one or more components, molding to form one or more components, or direct fabrication to form one or more components. Alternatively, or in combination, the components may be manufactured using direct fabrication based on a computer model of the lens. The lens components may be manufactured separately or together using direct fabrication. The lens may be directly fabricated as a single piece lens with the components described herein.

[0257] In many embodiments, the intraocular lens is manufactured in two component pieces, a top component 4100a and a bottom component 4100b. The materials used can be compatible, such as hydrophilic acrylic or hydrogel. Other materials can be used alternatively or in combination. The two components 4100a and 4100b can be assembled as shown in FIG. 41A by bonding the top component 4100a to the bottom component 4100b at the joint 4101. The cavity 4105 between the two components 4100a and 4100b can be filled with a high refractive index fluid, resulting in a deformable fluid space within the intraocular lens 4100 that functions as a lens with variable optical power.

[0258] The peripheral bellows region 4103 may comprise a continuous fluid reservoir or chamber defined by multiple folds of the top and bottom components 4100a, 4100b, which folds define an inner bellows 4103a and an outer bellows 4103b. The top and bottom components 4100a, 4100b may fold inwardly between the inner bellows 4103a and the outer bellows 4103b, which defines a conformable region between the inner bellows 4103a and the outer bellows 4103b. This conformable region may define one or more fluid channels between the inner bellows 4103a and the outer bellows 4103b. The fluid channel(s) may be annular, circumferential, or rotationally symmetric in shape, such as the inner bellows 4103a and the outer bellows 4103b. In the anterior-posterior direction, this conformable region may be thinner than the inner bellows 4103a and the outer bellows 4103b.

[0259] The top component 4100a may comprise a deflectable, planar member 4110 (FIG. 41C), and the bottom component 4100a may comprise a plano-convex member 4120 that may provide optical power (FIG. 41B). Alternatively, the bottom component 4100a may comprise a planar member that provides substantially no optical power, and the top component 4100b may be pre-curved (or in the form of a shell) to provide a certain shape to the cavity 4105 that may be filled with a refractive fluid to provide optical power. When placed in the capsular bag, the top component 4100a may be in an anterior position and the bottom component 4100b may be in a posterior position. Alternatively, the top component 4100a may be in a posterior position and the bottom component 4100b may be in an anterior position.

[0260] The function of the double fold in the plurality of bellows features 4103 may be to increase the mechanical responsiveness of the intraocular lens 4100. The outermost 4103c of the bellows 4103 may interact with the capsular bag of the eye. When the bag exerts pressure on the bellows 4103, fluid may be displaced from the bellows region 4103 into the central lens cavity 4105. The increased pressure and volume of fluid in the central lens cavity 4105 typically causes the upper lens portion 4100a to deform upwards, changing its radius of curvature, resulting in strength changes and accommodation. For example, the planar member 4110 may deflect upwards and undergo a decrease in radius of curvature. Alternatively, or in combination, the separation distance between the two components 4100a and 4100b may increase in response to increased pressure, changing the optical power (i.e., the regions of the components 4100a and 4100b that define the outer edge of the central lens region 4104 may separate in the anterior-posterior direction). The innermost bellows 4103a may be adapted such that its outermost wall may be highly compliant. Pressure exerted from the innermost wall of the outermost bellows 4103b due to a force applied to the outermost fold within the bellows may be translated into displacement of fluid from the innermost bellows 4103a cavity. Thus, even if the bond lines along the outermost bellows 4103 provide increased stiffness, it may still be possible for deformation to occur in the innermost bellows 4103a.

[0261] The bellows region 4103 may be rotationally symmetric about the optical axis of the lens region for ease of manufacture. The rotationally symmetric structure of the bellows may be easily machined on a lathe or may be formed from a mold that can be easily turned.

[0262] A plurality of protrusions, or projections, or posts 4102 may be radially disposed on the inner surface 4106b of the bottom component 4100b, or alternatively, the inner surface 4106a of the top component 4100a, and combinations thereof, as shown in, for example, FIG. 41A and FIG. 41B. The projections or posts 4102 may function to hold the gap between the two components, thereby facilitating fabrication. In some embodiments, the projections or posts 4102 may be bonded to other components of the intraocular lens 4100 after the top component 4100a and the bottom component 4100b are brought together. The space between adjacent projections or posts 4102 may function as a conduit for fluid between the bellows 4103 and the cavity 4105. In some embodiments, the projections or posts 4102 are free from other components of the intraocular lens 4100, minimizing asymmetric deformation of the opposing planar members. In some embodiments, the planar member facing the protrusions or posts 4102 may include an outer annular region in contact with the protrusions or posts 4102 and a deflectable inner circular region raised and separated from the outer annular region and the protrusions or posts 4102.

[0263] The top portion 4100a and the bottom portion 4100b comprising the top and bottom components can be formed in many ways. For example, the top portion 4100a and the bottom portion 4100b can be formed, for example, by machining the respective parts on a lathe or by molding. In many embodiments, the top and bottom portions each comprise a rotationally symmetric structure, such as a bellows and other components as described herein. The protrusions can be formed in many ways. The rotationally symmetric components can be joined together to form a lens as disclosed herein.

[0264] The bellows 4103a and 4103b as disclosed herein can provide improved coupling of the fluid reservoir with the capsular bag of the eye. The folded structure of the bellows 4103a and 4103b can provide a resilient spring function to the reservoir such that the reservoir can be gently biased against the capsular bag and the capsular bag can be allowed to move inward to move fluid from the reservoir to the inner lens structure to provide the optical power.

[0265] The protrusions 4102 can be formed in many ways to provide for fluid movement and separation of the anterior lens component 4100a and the posterior lens component 4100b. For example, the protrusions 4102 can provide individual protrusions, projections, or posts. Alternatively, the protrusions 4102 can comprise portions of an annular structure such as a rim. The rim can have a channel cut at least partially into the rim to allow for fluid movement. The multiple protrusions are separated from one another to define multiple channels 4107 defined by the multiple protrusions to fluidly connect the chamber to the reservoir.

[0266] The protrusions 4102 can be located away from the optically used portions of the lens 4100 to reduce optical aberrations and distortions.

[0267] Any of the features of the intraocular lens 4100 may be combined with any of the features of the other intraocular lenses described herein, and vice versa.

[0268] 42 shows a cross-sectional view of an accommodating intraocular lens 4200, an embodiment of which comprises a similar structure to the accommodating intraocular lens 4100. The first component 4200a may comprise a deflectable, planar member 4210, and the second component 4200b may include a shell member 4220 that incorporates an optical gel or fluid that may provide optical power. The first component 4200a and the second component 4200b are secured at a seam 4201. A plurality of protrusions 4202 may be radially disposed on the inner surface 4206 and may function to maintain a gap between the two components, thereby facilitating fabrication. The protrusions 4202 may define a plurality of channels 4207, which may fluidly couple the chamber to the bellows.

[0269] The accommodating intraocular lens 4200 is configured such that the chamber 4205 extends into the second component. The second component may include a reduced amount of solid material compared to the lens 4100, which may facilitate folding, rolling, or compressing the lens 4200 to a smaller cross section to configure a lens with a narrow insertion profile to fit within a narrow incision in the eye.

[0270] The optical axis 4240 extends through the central lens region 4204 of the accommodative lens system 4200, i.e., the first component coupling structure 4207a and the second component coupling structure 4207b extend circumferentially around the central lens region 4204 that includes the optical axis. The plurality of bellows features 4203 illustrates a double-fold bellows including an innermost bellows 4203a, an outer bellows 4203b, and an outermost bellows region 4203c. The bellows feature 4203 may include a first fold 4208a on the first component and a second fold 4208b on the second component.

[0271] Any of the features of the intraocular lens 4200 may be combined with any of the features of the other intraocular lenses described herein, and vice versa.

[0272] FIG. 43 illustrates an AIOL system 4300 comprising a fixed lens 4330 (fixed-power lens) and an accommodative lens unit having a fluid-filled structure 4340. The fluid-filled structure 4340 is related in operation to the structure of the AIOL 4200, but the fluid-filled structure 4340 may have a negative foundation force, or no foundation force or positive foundation force with respect to the structural elements when the AIOL system 4300 is in a relaxed state (e.g., no external pressure is applied to the bellows structure 4303). The fluid-filled structure 4340 may include a first component 4340a (e.g., a first structural element) and a second component 4340b (e.g., a second structural element) secured together at a seam or joint 4301 using, for example, a glue or bonding agent, as previously described herein. The joint 4301 may be substantially similar to any of the joints or seams previously described herein. For example, the joint 4301 may extend circumferentially around the first component 4340a and the second component 4340b. The first component 4340a and / or the second component 4340b may have protrusions 4302 (also referred to herein as posts) located on an inner surface of one or more of the first component 4340a and the second component 4340b, and the first component 4340a and the second component 4340b may be selectively secured to one another at the protrusions 4302, similar to the joint 4301. Alternatively, or in combination, the protrusions 4302 may be disposed on the first rigid coupling structure 4307a of the first component 4340a and / or the second rigid coupling member 4307b of the second component 4340b. The protrusion 4302 may, for example, provide a gap between the first component 4340a and the second component 4340b, separating the first component 4340a and the second component 4340b as previously described herein.

[0273] The fluid filled structure 4340 may include a chamber 4305 and an outer portion 4308 at least partially defining a fluid reservoir 4303 that extends at least partially around the chamber 4305. The fluid reservoir 4303 may comprise a continuous baffle structure disposed around an outer edge of the fluid chamber 4305. The fluid reservoir 4303 may define, for example, a bellows region. The continuous structure of the fluid reservoir 4303 may have an annular, elliptical, and / or rotationally symmetric shape, as described hereinabove. In other embodiments, the outer portion 4308 of the fluid filled structure 4340 may be rotationally asymmetric with respect to the optical axis of the AIOL 4300. The fluid reservoir 4303 may comprise a haptic structure that engages the lens capsule, as described hereinabove.

[0274] Fluid filled structure 4340 may contain a relatively high refractive index optical fluid in a fluid reservoir 4303 and a chamber 4305. The chamber 4305 and the fluid reservoir 4303 are in fluid communication with one another such that the optical fluid can flow between the fluid reservoir 4303 and the chamber 4305 in response to a force applied to the fluid reservoir 4303. In the embodiment shown in FIG. 43, the fluid reservoir 4303 is more specifically the volume between the inner surface of the outer region of the first component 4340a and the inner surface of the outer region of the second component 4340b, as previously described herein. The fluid reservoir 4303 may comprise one or more folds 4309a and 4309b extending continuously and circumferentially around the optical axis of one or more of the first component 4340a and the second component 4340b, as previously described herein, and the folds 4309a and 4309b may extend toward one another such that the fluid reservoir 4303 comprises a plurality of bellows, including an inner bellows and an outer bellows. The fluid reservoir 4303 may comprise a conformal fold region between the inner bellows and the outer bellows of the plurality of bellows, as previously described herein.

[0275] The chamber 4305 may be defined between an inner surface of the first optical component 4310 defined by an interior region of the first component 4340a and an inner surface of the second optical component 4350 defined by an interior region of the second component 4340b. The first optical component 4310 and the second optical component 4350 may each be surrounded by a fluid reservoir 4303. In the embodiment illustrated in FIG. 43, the fluid reservoir 4303 extends continuously and circumferentially around the first optical component 4310 and the second optical component 4350. Furthermore, in the embodiment of the AIOL system 4300 illustrated in FIG. 43, a protrusion 4302 is disposed between the optical components 4310 and 4350 and the fluid reservoir 4303, as previously described herein, to define a plurality of fluid channels or conduits between the chamber 4305 and the fluid reservoir 4303. Thus, as previously described herein, the fluid reservoir 4303 and the chamber 4305 are in fluid communication with each other to change the optical power of the AIOL in response to changes in the shape of the capsular bag.

[0276] The first rigid bonding region 4307a and the second rigid bonding region 4307b can be configured to constrain radial movement of the optical components 4310 and 4350 relative to the outer region as previously described herein. Thus, the first and second bonding regions 4307a-b maintain the optical alignment of the optical components 4310, 4350 (e.g., the periphery of the optical components 4310, 4350 is maintained within a desired working dimension) while a force is applied against the fluid reservoir 4303.

[0277] The second component 4340b may further comprise an engagement feature 4331 (e.g., coupling feature), such as a releasable locking feature or capture feature, that can capture (e.g., hold) the fixed lens 4330 such that the fixed lens 4330 may be coupled to the second component 4340b as shown. Alternatively, the fixed lens 4330 may be coupled to the first component 4340a rather than the second component 4340b. The fixed lens 4330 outer edge is configured to be within the outer edge of the first component 4340a and / or the second component 4340b. The fixed lens 4330 is configured to snap-fit ​​onto the first component 4340a and the second component 4340b, and in some embodiments, the fixed lens 4330 is configured to be releasably attached to either the first component 4340a or the second component 4340b.

[0278] Additionally, the fixed lens 4330 and the first component 4340a and / or the second component 4340b may be configured such that the fixed lens 4330 may be releasably coupled to the first component 4340a or the second component 4340b in-situ in the patient's eye, such as in the eye's natural capsule, after the assembled and fluid-filled structure 4340 is placed in the eye's natural capsule. When the second component 4340b is the anterior component, this allows the fixed lens 4330 to be removed from the accommodating lens unit and replaced in-situ by another fixed lens 4330. This feature allows the fixed optical power of the AIOL 4300 to be changed (adapted) after the accommodating lens unit is placed in the natural capsule without removing the accommodating lens unit from the natural capsule. The connecting features 4331 and / or fixed lens 4330 may be configured such that channels are present to allow body fluid to freely communicate with the open spaces 4334 and 4333.

[0279] The fixed lens 4330, for example, has an inner surface facing and adjacent to an outer surface of the first optical component 4310 or the outer surface of the second optical component 4350 of the first component 4340a or second component 4340b to which the fixed lens 4330 couples, respectively. The fixed lens 4330 may, for example, define a third component of the AIOL system 4300. The fixed lens 4330 may have an optical power.

[0280] The optical components 4310 and / or 4350 of the first component 4340a and / or second component 4340b, respectively, may include planar members. The optical components 4310 and / or 4350 may be biased to a configuration that does not provide optical power. For example, the first optical component 4310 may include a deflectable member configured to deflect from a neutral pressure planar shape to a curved shape in response to fluid movement between the fluid chamber 4305 and the fluid reservoir 4303. When the fluid reservoir 4303 is compressed and fluid is forced into the chamber 4305, the first optical component 4310 deflects upward from the neutral planar shape shown in FIG. 43 to an accommodation configuration in which the first optical component 4310 is curved (i.e., convex with respect to the second optical component 4350). In the accommodation configuration, the fluid in the chamber 4305 and the first optical component 4310 deliver an optical power that dynamically changes based on compression of the fluid reservoir 4303. Deflection of the first optical component 4310 may change the dimensions and / or shape of the fluid chamber 4305, such as a change in the separation distance between the inner surfaces of the optical components 4310 and 4350, causing a change in the radius of curvature of the first optical component 4310, as previously described herein. The optical power provided by the fluid in the chamber 4305 in combination with the shape of the first optical component 4310 may, for example, cause a portion of the optical power change of the AIOL system 4300. The second optical component 4350 may have a larger cross-section (e.g., thickness) than the first optical component 4310, such that the second optical component 4350 deforms less than the first optical component 4310 or does not deform at all. To the extent that the second optical component 4350 deforms, the degree of deformation of the second optical component 4350 can be adjusted by the depth of the free 4334 space between the second lens component 4340b and the fixed lens 4330. In some embodiments, the depth of the free space 4334 is such that solid surfaces of the optical field cannot contact each other.

[0281] One or more of the optical components 4310 and / or 4350 may include a shell, such as a non-planar shell, as previously described herein. As previously described herein, the first component 4340a may include a front component and the second component 4340b may include a rear component. Alternatively, the first component 4340a may define a rear component and the second component 4340b may define a front component.

[0282] Although optical components 4310 and 4350 are shown as planar members in Figure 43, either one may include a separate plano-convex member shaped to provide the optical power while the other of optical components 4310 and 4350 includes a planar member. Optical components 4310 and 4350 can be configured as toric elements.

[0283] One or more of the first component 4340a and the second component 4340b may comprise a polymeric material, as previously described herein. The first component 4340a and the second component 4340b may be sufficiently flexible to be folded into a reduced cross-sectional delivery configuration for delivery to the eye, as previously described herein. The first component 4340a and the second component 4340b may be bonded to one another, as previously described herein. The first component 4340a and the second component 4340b may be fabricated as previously described herein. The third component (i.e., the fixed lens 4330) may likewise be sufficiently flexible to be folded into a reduced cross-sectional delivery configuration for delivery to the eye, and may be fixedly (e.g., permanently or releasably) coupled in-situ to the first component 4340a or the second component 4340b, as previously described.

[0284] The fluid may include any of the fluids previously described herein. The fluid in the fluid chamber 4305 may provide optical power.

[0285] The dimensions and geometry of the accommodating lens systems described herein may be varied. For example, FIG. 44 illustrates an alternative AIOL system 4400 similar to AIOL system 4300, with the last two digits of the reference numbers indicating similar structures. AIOL system 4400 differs from AIOL system 4300 in that AIOL system 4400 has a second optical component 4450 that is thinner than the second optical component 4350 of second component 4340b. As a result, the second optical component 4450 may deform in a manner that adds optical power to the accommodating lens compared to the second optical component 4350 of second component 4340b, and the second component 4340b may be biased to provide no optical power. Further thinning of the second optical component 4450 within the optical field may be provided by the relief 4434. The fluid reservoir 4403 also differs from the fluid reservoir 4303 in that the fluid reservoir 4403 may include two folds in only one half of the structure of 4440. For example, the exterior region 4440a of the first component may include two folds 4408 while the exterior region 4440b of the second component has none (e.g., the rear half of the fluid reservoir 4403 includes two folds 4408).

[0286] In other examples, the geometry of the fluid-filled chamber or bellows, or other fluid reservoir structure may be altered. For example, FIG. 45 illustrates an AIOL system 4500 that is similar in structure to the AIOL system 4400, with the last two digits of the reference number indicating the similar structure. The fluid-filled bellows structure 4503 may have a rectilinear cross-sectional shape that extends circumferentially around the outer portions of the first component 4540a and the second component 4540b, for example.

[0287] The various peripheral fluid reservoir structures of the AIOL4200, 4300, 4400, 4500 may provide a means to control the stiffness of the fluid reservoir and thereby control the relationship between varying accommodation and the forces applied to the structures by the eye, as previously described herein.

[0288] 46A, 46B, 46C illustrate yet another embodiment of an AIOL system 4600, similar to the AIOL systems 4300, 4400, 4500 described above, with the last two digits of the reference number indicating similar structure from FIG. 43 to FIG. 46C. The AIOL 4600 can be made from four main parts including a first component 4640a, a second component 4640b, a fixed lens structure 4630 defining a third component, and a thin-walled ring 4640c defining a fourth component. The AIOL 4600 includes a fluid reservoir 4603 defined by the thin-walled ring 4640c and outer portions of the first component 4640a and the second component 4640b. The thin-walled ring 4640c may be secured to the first component 4640a and the second component 4640b at a seam or joint 4601 such that the thin-walled ring 4640c connects the outer edges of the first component 4640a and the second component 4640b to one another. The thin-walled ring 4640c may be made of a material having different material properties than the remaining components of the structure. In some embodiments, the thin-walled ring 4640c may be made of a version of the polymer used to make the first component 4640a and the second component 4640b with a reduced modulus of elasticity. As such, the thin-walled ring 4640c may be made more easily or with a thinner cross-section than would otherwise be possible. Alternatively, or in combination, the thin-walled ring 4640c may be spin cast or centripetally cast, allowing for a thinner structure than could be achieved by machining. This particular embodiment is expected to provide better response to natural anatomy movements, and in certain instances, provides greater response to lower pressures.

[0289] The fixed lens structure 4630 can include, for example, a convex-concave configuration. Haptic-like structures 4635 can be used to engage at the connecting feature 4631. The relief 4634 is created by offsetting the convex surface of the fixed lens 4630 with the haptic-like structures 4635.

[0290] FIG. 47 illustrates an AIOL system 4700 that is a variation of the AIOL system 4600 shown in FIGS. 46A-46C. In FIG. 47, various structures are indicated by various reference numbers, with the last two digits of the reference number indicating structures similar to those described above. The connection area between the first component 4740a and the third component 4740c and the connection area between the second component (e.g., the second component 4640b shown in FIGS. 46B and 46C) and the third component 4740c may have multiple slots 4770 to allow for a less rigid structure. The slots 4770 may be made in the components of the AIOL system 4700 prior to assembling the fluid-filled structure 4740, or the slots 4770 may be made after the components are assembled. When added after the structure is assembled, the slots 4770 may be made by one or more of machining cuts, laser cuts, and other suitable means. The slot 4770 can be made such that a portion of the seam remains uncut and the slot 4770 extends partially down the seam such that a seal remains between the components of the AIOL.

[0291] 48A, 48B, and 48C illustrate aspects of an alternative embodiment of an AIOL system 4800 similar to the embodiments of AIOL systems 4300, 4400, 4500, 4600, and 4700 described above with respect to FIGS. 43 through 47. The AIOL system 4800 comprises a fixed lens 4830 and a fluid-filled structure 4840 including a first structural element 4840a and a second structural element 4840b. The first structural element 4840a can include an inner region that defines a first optical component 4810, a rigid annular bonding region 4807 around the first optical component 4810, and an outer region 4808 around the rigid bonding region 4807. The rigid bonding region 4807 can be an annular wall that performs any of several functions: 1) the rigid bonding region 4807 isolates the first optical component 4810 from external forces applied against the outer region 4808 and maintains the optical alignment of the first optical component 4810; 2) the rigid bonding region 4807 has a height that forms a cavity 4841 in the space between the fixed lens 4830 and the first optical component 4810; 3) the rigid bonding region 4807 maintains a shape at the forward end and holds the fixed lens 4830 firmly in place as the fluid reservoir 4803 deforms; and 4) the rigid bonding region 4807 defines a set internal boundary of the fluid reservoir 4803 so that optical fluid is directed into the accommodating lens. The first structural element 4840a and the second structural element 4840b are joined together at a seam 4801 to define a fluid reservoir 4803 at an outer portion 4808 of the fluid-filled structure 4840, shown in the cross-sectional assembly view of FIG. 48A. The first structural element 4840a can be an anterior component facing anteriorly with respect to the natural lens capsule, such that the cavity 4841 defines an anterior space between the first optical component 4801 and the fixed lens 4830. The second structural element 4840b can include the second optical component 4850. The second optical component 4850 can be more rigid than the first optical component 4810. For example, the second optical component 4850 can be rigid (e.g., stiff) and the first optical component 4810 can be flexible.

[0292] The space 4812 between the first optical component 4810 and the second optical component 4850 can be filled with an optical fluid. The fluid-filled structure 4840 has a fluid channel 4849 (FIG. 48A) between the fluid reservoir 4830 and the space 4812 between the first optical component 4810 and the second optical component 4850. In operation, optical fluid passes between the fluid reservoir 4830 and the space 4812 in response to a force applied by the natural lens capsule. As pressure in the space 4812 increases, at least the first optical component 4810 deflects forward within the cavity 4841 toward the fixed lens 4830, dynamically changing the optical power of the AIOL system 4800 and providing accommodation. The optical fluid in the space 4812 and at least the first optical component 4810 accordingly define an accommodative lens.

[0293] Another feature of the AIOL system 4800 is the connection between the first structural element 4840a and the second structural element 4840b (best shown in FIG. 48C). The first structural element 4840a may further comprise a coupling pin 4855, and the second structural element may further comprise a receiver 4856 configured to receive the coupling pin 4855. The coupling pin 4855 projects downwardly from the rigid coupling region 4807 of the first structural element 4840a in the orientation shown in FIG. 48C, and the receiver 4856 may be a through hole in the periphery of the second optical component 4850. The second structural element 4840b further includes standoffs 4857, and when the first structural element 4840a and the second structural element 4840b are coupled together at coupling pin 4855, the receptors 4856 form fluid channels 4849 (FIG. 48A) through which optical fluid can flow between the fluid reservoir 4803 and the space 4812 between the first and second optical components 4850. Additionally, the fluid-filled structure 4840 may have a square-edged annular region 4851 that provides a barrier for cell migration from the outer edge of the natural lens capsule into the optical portion of the lens 4800. Such cell migration may cause post-operative opacification of the optical system.

[0294] The fixed lens 4830 shown in FIGS. 48A and 48B includes at least one passageway 4820, such as a hole or cutout (e.g., a recess), on its periphery that allows aqueous fluid within the natural lens capsule to pass through the fixed lens 4830 and into or out of the cavity 4841. For example, the natural aqueous fluid in the cavity 4841 passes through the passageway 4820 in the fixed lens 4830 in response to a change in shape of the first optical component 4810. Thus, the passageway 4820 allows the natural aqueous fluid to wet the first optical component 4810 such that the first optical component 4810 maintains a desired performance while the first optical component 4810 can be deflected forward while liquid is in the cavity 4841.

[0295] The fixed lens 4830 may be attached to the rigid coupling region 4807 of the first structural element 4840a at the fixed lens receptor 4831 located at or near the anterior portion of the cavity 4841 (detailed in cross section in FIG. 48C). The fixed lens receptor 4831 and the fixed lens 4830 are configured such that the fixed lens 4830 may be attached to the first structural element 4840a and removed from the first structural element 4840a after the fluid-filled structure 4840 is implanted in the natural capsular bag. This is possible because the fixed lens 4830 is attached to the anterior portion of the fluid-filled structure 4840. This design may provide the corrective power of the fixed lens required by the patient at the time of the procedure after the fluid-filled accommodative portion 4840 is placed in the natural capsular bag. Additionally, the fixed lens 4830 and lens receptor 4831 are configured such that the fixed lens 4830 can be removed in-situ from the fluid filled portion, such that a fixed lens 4830 of one optical power can be replaced with a fixed lens 4830 of a different optical power, and the optical power of the fixed lens 4830 can be adjusted in-situ. This configuration is expected to provide better efficacy since the shape of the accommodating lens unit may not be the same after implantation compared to before implantation, and at the same time, the fixed optical power can be determined based on the actual shape and power of the accommodating lens unit after implantation. Additionally, a patient's vision may change over time, and the fixed lens may be altered as the patient's prescription changes.

[0296] FIG. 49A is a top view and FIG. 49B is a cross-sectional side view of an alternative embodiment in which the second structural element 4840b of the embodiment shown in FIG. 48A-C is replaced with a second structural element 4940b. The second structural element 4940b includes a thickening feature 4960 in a portion of the fluid reservoir 4903. As shown most clearly in FIG. 49A, the thickening feature 4960 is on only one side of the second structural element 4940b, and the thickening feature 4960 extends around only a portion of the circumference of the second structural element 4940b. The thickening feature 4960 provides a longer member path for use in reaching the interior of the complete assembly via a needle or tubular member used to deliver fluids to and remove gas from the interior of the assembly. The longer path of the needle through the bulk material of 4960 provides additional surface area to seal the path when the tubular member is removed, potentially eliminating the need for an additional sealing procedure after the needle is removed. As shown, the second structural element 4940b also includes an alternative receiver 4956 defined by a recess, as opposed to the through-hole receiver 4856 in the embodiment shown in FIG.

[0297] FIG. 50 illustrates yet another embodiment of an AIOL system 5000 similar to the embodiment illustrated in FIGS. 48A-49B. The AIOL system 5000 includes a fixed lens 5030 and a fluid-filled unit 5040 having a first structural element 5040a and a second structural element 5040b. The second structural element 5040b includes a number of annular regions 5051 having a square outer edge. These four annular regions 5051 incorporated in the posterior and anterior regions of the bellows structure provide additional protection against cell migration involved in opacifying the posterior capsule. The embodiment of the AIOL system 5000 further incorporates two thickening features 5060 diametrically opposed to each other to allow for fluid inflow and fluid outflow during the filling procedure. These features are shown in cross section and correspond to circumferential angles similar to those of the thickening feature 4960 illustrated in FIGS. 49A and 49B. The first structural element 5040a of the AIOL system 5000 further includes a standoff 5055 that contacts a contiguous receptor ring 5056 of the second structural element 5040b. In Figure 50, various structures are indicated with various reference numbers, with the last two digits of the reference numbers indicating configurations similar to those described in Figures 48A-49B.

[0298] 51 and 52 illustrate AIOL systems 5100 and 5200 similar to the AIOL systems illustrated in FIGS. 48A-50B in which additional features have been incorporated to improve performance. Both embodiments include features that improve performance when the AIOL system includes a toric lens. The toric lens can be in either the accommodative or fixation portion. These features primarily minimize rotation of the optical components relative to themselves and / or relative to the capsule in which they are implanted. As illustrated here, the fixation lens 5130 or 5230 is configured to be toric. The AIOL systems 5100 and 5200 include a capsule rotation constraint 5166 (FIGS. 51A and 51C) and 5266 (FIGS. 52A and 52C) on the outer periphery that engages the capsule and inhibits rotation of the AIOL systems 5100 and 5300 within the natural lens capsule. The capsular rotation constraints 5166 and 5266 can be thickened portions of the first structural elements 5140a, 5240a and / or second structural elements 5140b, 5240b at the outer edge of the AIOL systems 5100 and 5200, respectively. Alternative embodiments of the capsular rotation constraints can be any feature that engages the native capsule more tightly on the outer edge than other surfaces. Alternatively, the AIOL systems 5100 or 5200 can have only one or more capsular rotation restraints 5166 or 5266.

[0299] In addition to the capsule rotation constraints 5166 and 5266, the AIOL systems 5100 and 5200 can also include features that rotationally maintain the orientation of the fixed lens relative to the accommodation portion of the AIOL system. The fixed lens rotation constraints or toric indexing features of the AIOL systems 5100 and 5200 provide this feature. The fixed lens 5130 of the AIOL system 5100 has a number of passages 5120 defined by notches or holes along the circumference of the fixed lens 5130, and defines a receiver 5167 at the location of one of the passages 5120 to guide the proper orientation of the fixed lens 5130 relative to the first structural element 5140a. The first structural element 5140a includes a key 5168 at a corresponding radial location to align the toric fixed lens 5130. The receiver 5167 and the key 5168 together define a toric indexing feature 5170. The fixed lens 5130 may further include an annular indexing mark 5169 on or within the fixed lens 5130 that indicates which passageway 5120 the receiver 5167 is to be aligned with the key 5168. Alternatively, instead of having an annular indexing mark 5169, the key / receiver for correct alignment can have a different shape (e.g., triangular) than the other passageways 5120 in the lens (e.g., curved). FIG. 52 illustrates an alternative embodiment in which the receiver 5267 is a notch or recess in the inner circumference of the first structural element 5240a and the annular fixed lens 5230 includes a key 5268 configured to mate with the receiver 5267.

[0300] As described in co-pending provisional applications 62 / 334,998 and 62 / 331,407, the thickened regions of the pouch rotation constraints 5166 and 5266 of the AIOL systems 5100 and 5200 further provide a stronger leading edge for use when delivering the AIOL systems 5100 and 5200 through a narrow bore stenosis or tube of an AIOL delivery device. One of the thickened rotation constraints 5166 and 5266 can be positioned to be the leading edge of the AIOL systems 5100 and 5200, and the other can be positioned to be the trailing edge as they pass through the narrow bore or tube of the delivery device. By having the thickened rotation constraint define a leading edge during delivery, the leading edge of the AIOL systems 5100 and 5200 can hold more pressure when fluid is trapped in the leading section of the AIOL system during delivery after the distalmost portion enters the restricted area of ​​the delivery instrument.

[0301] FIG. 53 illustrates diagrammatically how one of the thickened rotation constraints 5166 of the AIOL system 5100 operates at the distal end of the delivery device 5300 during delivery. The AIOL system 5100 is shown properly oriented with respect to the pouch rotation constraint 5166 and entering the injection end 5375 for delivery. The AIOL system 5100 conforms to the delivery instrument constriction while being pushed through the insertion funnel 5376 by the distal end of the plunger 5377 with the flexible distal end 5378. It will be appreciated that the internal pressure of the fluid in the AIOL system 5100 increases as it is compressed in the funnel 5376. The thickened rotation constraint 5166 at the leading edge provides more material to withstand the increased pressure and prevent the leading end from bursting during delivery.

[0302] 54A-54C illustrate an alternative AIOL system 5400 that includes at least one intermediate bellows attachment feature 5471 (illustrated in cross-section in FIG. 54B and FIG. 54C). The AIOL system 5400 is similar to the embodiment of the AIOL system 5200 described above. For example, the illustrated embodiment of the AIOL system 5400 includes upper and lower structural elements 5440a and 5440b, respectively, that are joined together at a seam 5401 that defines a bellows region 5403. The AIOL system 5400 further includes a fixed lens 5430, a first optical component 5410, a second optical component 5450, and a space 5412 between the first optical component 5410 and the second optical component 5450. At least one of the first optical component 5410 and the second optical component 5450 is deformable (e.g., can bend forward and / or backward), and in some embodiments, the first optical component 5410 is more deformable than the second optical component 5450. For example, the first optical component 5410 can be a thin, flexible member, while the second optical component 5450 can be at least substantially rigid (e.g., does not bend in a manner that changes optical power). The first optical component 5410 and / or the second optical component 5450 in combination with the optical fluid in the space 5412 define a fluid-adjustable lens. The AIOL system 5400 also includes (a) a thickening feature 5460, described above for feature 4960, that facilitates fluid delivery during the filling procedure, and (b) a square-shaped annular edge 5451 that provides a barrier to cell migration from the outer edge of the patient's capsule to the portion of the AIOL system 5400 in the optical path.

[0303] The intermediate bellows attachment feature 5471 may comprise an upper mating element 5471a and a lower mating element 5471b that are integral with the upper structural element 5440a and the lower structural element 5440b, respectively. The upper mating element 5471a and the lower mating element 5471b are joined together at a mating region 5472. The intermediate bellows attachment feature 5471 may be distributed circumferentially around the intermediate section of the bellows structure 5403 at a plurality of discrete locations spaced apart from one another. For example, in the embodiment of the AIOL system 5400 shown in FIGS. 54A-54C, the intermediate bellows attachment feature 5471 is evenly distributed around the intermediate section of the bellows region 5403 at eight spaced apart locations (not shown), although the bellows attachment feature 5471 is not limited to a particular number.

[0304] The intermediate bellows attachment feature 5471 is expected to more efficiently transfer fluid from the bellows structure 5403 to the accommodative lens space 5412. More specifically, without the intermediate bellows attachment feature 5471, the apexes of the outer edges of the upper structural element 5404a and the lower structural element 5404b tend to separate from one another as pressure increases in the bellows structure 5403. The intermediate bellows attachment feature 5471 limits undesired or excessive expansion or the like in the midsection of the bellows structure 5403 during accommodation by inhibiting the apexes of the outer edges of the upper structural element 5404a and the lower structural element 5404b from separating. The intermediate bellows attachment feature 5471 thus stabilizes the volume of the midsection of the bellows structure 5403 as fluid flows into the space 5412, more efficiently transferring accommodation fluid from the bellows structure 5403 to the accommodative lens space 5412. FIG. 54B illustrates a section through the AIOL system 5400 passing through two of the intermediate bellows mounting features 5471, and FIG. 54C illustrates a section of the AIOL system 5400 passing through two spaces between the intermediate bellows mounting features 5471, allowing fluid to pass from the outer periphery of the bellows to the space 5412 of the fluidically accommodating lens.

[0305] The intermediate bellows attachment feature 5471 is not limited to use in the embodiment of AIOL system 5400 described above with respect to Figures 54A-C, but rather may be incorporated into any suitable embodiment of an AIOL system disclosed herein. For example, some of the AIOL systems described above having a bellows structure may incorporate the intermediate bellows attachment feature 5471 into embodiments of AIOL systems 3900, 4100, 4200, 4300, 4400, 4800, 5000, 5200, 5300, etc., but are not limited thereto.

[0306] In embodiments such as, but not limited to, any of the embodiments illustrated in Figures 43 through 54C, some or all of the portions not within optical path XX can be constructed from components that have been dyed or treated to reduce light throughput, limiting the ability of stray light incident portions outside the optical path from scattering into optical path YY, as shown in Figure 51B.

[0307] The fixed lenses according to any of the embodiments described herein may be spherical, aspheric, toric, or any other known lens configuration. Alternatively, or in combination, the fixed solid lenses may be plano-convex, convex-concave, or concave-convex. The fixed lenses may be configured to have positive or negative fixation power.

[0308] The fluid lenses described herein may be configured to have one or more conditioning surfaces, for example, two conditioning surfaces.

[0309] In some embodiments, the optical fluid may consist of high refractive index polyvinyl alcohol.

[0310] The AIOL devices described in Figures 43 through 54C (AIOL4300, 4400, 4500, 4600, 4700, 4800, 4900, 5000, 5100, 5200, 5400, etc.) may be implanted in the following manner: The eye may be prepared and the native lens may be removed from the capsule in any suitable manner. Next, a fluid-filled structure may be placed in the capsule of the eye. The patient may then be evaluated for base optical power and or astigmatism correction to select a fixed lens. The selected fixed lens may then be inserted into the pre-implanted, fluid-filled structure of the AIOL. The selected fixed lens may then be bonded to the fluid-filled structure in the capsule of the eye. As mentioned above, one or more of the fluid-filled structure or the fixed lens, respectively, may be flexible enough to be reconfigured (e.g., folded) into a reduced-profile delivery configuration for delivery into the capsular bag. In some instances, further correction to the fixation portion may be required after surgery. Such instances may occur any time from days to years after surgery. At such times, the patient may return to the physician to replace the fixation lens with a new fixation lens having a different optical power or other prescription. In such instances, the new prescription may be characterized before or after the original fixation lens is removed. In such instances, a new fixation lens may be created and implanted at the time of the examination, and in other instances, the patient may return to have the fixation lens implanted sometime after the examination.

[0311] In some embodiments, the fixation portion of the AIOL may be made of a different material than the accommodative portion. Such materials include hydrophilic or hydrophobic methacrylates or silicones, and any other materials traditionally used in non-accommodative IOLs. The fixation lens may be made of a harder material than the material used for the accommodative portion.

[0312] Any of the features of the intraocular lens systems described in Figures 43 through 54 may be combined with any of the features of the other intraocular lenses described herein, and vice versa.

[0313] Although preferred embodiments of the present disclosure have been shown and described herein, it will be apparent to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will be envisioned by those skilled in the art in the future without departing from the present invention. It should be understood that various alternatives to the embodiments of the present disclosure described herein may be adopted in the practice of the present disclosure. The following claims define the scope of the present invention, and it is intended that methods and structures within the scope of these claims and their equivalents be covered thereby.

Claims

1. 1. An accommodating intraocular lens (AIOL) system for placement within a subject's capsular bag, the AIOL system comprising: An adjustable lens unit, comprising: a first component (4340a) having a first optical component (4310); a second component (4340b) having a second optical component (4350) rearwardly relative to the first optical component (4310); a chamber (4305) between the first optical component (4310) and the second optical component (4350); a fluid reservoir (4303) extending at least partially around said chamber (4305); an adjustable lens unit comprising: said chamber (4305) and said fluid reservoir (4303) in fluid communication such that an optical fluid can flow between said fluid reservoir (4303) and said chamber (4305) in response to a force applied to said fluid reservoir (4303); and said optical fluid in said chamber (4305) and said first optical component (4310) defining an optical power that changes dynamically based on the force applied to said fluid reservoir (4303); a fixed lens (4330) having a fixed optical power, the fixed lens (4330) being configured to be removably coupled to the adjustable lens unit such that the fixed lens (4330) is in front of and spaced apart from the first optical component (4310) of the adjustable lens unit; and An AIOL system comprising:

2. 2. The AIOL system of claim 1, wherein the chamber (4305) has a dimension and / or shape, and deflection of the first optical component (4310) in response to the force applied to the fluid reservoir (4303) changes the dimension and / or shape of the chamber (4305).

3. The AIOL system of claim 1 , wherein deflection of the first optical component (4310) changes a separation distance between inner surfaces of the first and second optical components (4310 and 4350).

4. The AIOL system of claim 1 , wherein deflection of the first optical component (4310) changes a radius of curvature of the first optical component (4310).

5. 2. The AIOL system of claim 1, wherein the first optical component (4310) comprises a deflectable member configured to deflect from a planar shape in a neutral pressure state to a curved shape in response to fluid movement between the chamber (4305) and the fluid reservoir (4303).

6. 2. The AIOL system of claim 1, wherein the optical power provided by the optical fluid in the chamber (4305) in combination with the shape of the first optical component (4310) produces a portion of the change in optical power of the AIOL system.

7. The AIOL system of claim 1 , wherein the first optical component (4310) and / or the second optical component (4350) are biased to a configuration that provides no optical power.

8. The AIOL system of claim 1 , wherein the fluid reservoir (4303) extends continuously circumferentially around the first and second optical components (4310 and 4350).

9. 2. The AIOL system of claim 1, wherein the second optical component (4350) is configured to deform less than the first optical component (4310) or not at all in response to the force applied to the fluid reservoir (4303).

10. The AIOL system of claim 1 , wherein the fixed lens (4330) is configured to be releasably attached to the first component (4340a).

11. 2. The AIOL system of claim 1, wherein the forward positioning of the fixed lens (4330) allows the fixed lens (4330) to be removed from the accommodative lens unit and replaced with another fixed lens while the accommodative lens unit is in place.

12. The AIOL system of claim 1 , wherein the fixed lens (4330) is configured to snap-fit ​​into the first component (4340a).

13. 2. The AIOL system of claim 1, wherein the fixed lens (4330) has a first outer edge of the fixed lens (4330) and the first component (4340a) has a second outer edge, and the first outer edge of the fixed lens (4330) is configured to be positioned within the second outer edge of the first component (4340a).

14. The AIOL system of claim 1 , wherein the fixed lens is a toric lens.

15. The AIOL system of claim 1 , wherein the fixation lens has a positive or negative fixation power.

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