High definition and extended depth of field via in VIVO subsurface modification of intraocular lens

Abstract

A lens, such as an IOL, includes at least one subsurface modification (comprising a modification to at least a portion of the internal structure of the IOL such as a modification to a plane or volume of the IOL) wherein the modification is achieved in vivo. The lens can can include an external surface feature (such as a shape change or contour on the external surface) on an anterior and / or posterior external surface of the lens. The subsurface modification achieves a desired optical effect on light that passes therethrough, such as to diffuse light, homogenize light, or redirect light.

Description

HIGH DEFINITION AND EXTENDED DEPTHOF FIELD VIA IN VIVO SUBSURFACE MODIFICATION OF INTRAOCULAR LENSCROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims priority to U.S. Patent Application No. 63 / 553,491, filed on February 14, 2024, entitled “HIGH DEFINITION AND EXTENDED DEPTH OF FIELD VIA IN VIVO SUBSURFACE MODIFICATION OF INTRAOCULAR LENS”, and U.S. Patent Application No. 63 / 655,212, filed on June 3, 2024, entitled “HIGH DEFINITION AND EXTENDED DEPTH OF FIELD VIA IN VIVO SUBSURFACE MODIFICATION OF INTRAOCULAR LENS”, the contents of which are hereby incorporated by reference in their entirety.BACKGROUND

[0002] Conventional optical lens solutions for extending depth of focus while eliminating common drawbacks include diffractive and refractive multifocal lenses having discrete zones. Other conventional solutions include aspheric lenses with a power profile that varies over the radius of the lens and small aperture (e.g., pinhole) lenses.

[0003] Such techniques have drawbacks. For example, in the case of an intraocular lens (IOL), the placement of discrete zones is sensitive to pupil size. If a particular power zone is either exposed by a dilated pupil or covered by a constricted pupil, it will dramatically change the resultant power of the IOL

[0004] There is a need for lens configurations that alleviate or eliminate such drawbacks.SUMMARY

[0005] Disclosed is a lens, such as an IOL, that includes at least one subsurface modification (comprising a modification to at least a portion of the internal structure of the IOL such as a modification to a plane or volume of the IOL) wherein the modification is achieved in vivo. The lens can include such a subsurface modification as well as an optional external surface feature (such as a shape change or contour on the external surface) on an anterior and / or posterior external surface of the lens. The subsurface modification is configured to achieve a desired optical effect on light that passes therethrough or otherwise interacts with the subsurface modification, such as to diffuse light, homogenize light, or redirect light for example.

[0006] In one aspect, there is disclosed a method of forming a customized lens, comprising: measuring at least one optical characteristic of a patient including: obtaining a biometry of an eye of the patient; obtaining an emmetropic power of the eye and an emmetropic power correction; obtaining a pupillary mobility of the eye; obtaining a pupil size of the eye; obtaining a low contrast sensitivity of the eye; obtaining a corneal aberration and a corneal topography of the eye; identifying at least one target specification of the lens based on the at least one optical characteristic; providing a lens; and using a laser to modify an aspect of the lens to achieve the at least one target specification. In an implementation, the laser forms a virtual aperture in the lens, wherein the virtual aperture surrounds an optical zone of the lens.

[0007] The details of one or more variations of the subject matter described herein are set forth in the accompanying drawings and the description below. Other features and advantages of the subject matter described herein will be apparent from the description and drawings, and from the claims.BRIEF DESCRIPTION OF THE DRAWINGS

[0008] Figures 1A, IB, and 1C illustrates an overall structure of an exampleIOL.

[0009] Figure 2 shows a schematic representation of a laser system that is configured to interact with a lens such as in vivo.

[0010] Figure 3 shows a schematic representation of a portion of the IOL.

[0011] Figure 4 shows a schematic representation of a portion of the IOL.

[0012] Figure 5-7 each show a side, schematic representations of a lens having a front surface and a back or rear surface.DETAILED DESCRIPTION

[0013] Before the present subject matter is further described, it is to be understood that this subject matter described herein is not limited to particular implemenations described, as such may of course vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting. Unless defined otherwise, all technical terms used herein have the same meaning as commonly understood by one skilled in the art to which this subject matter belongs.

[0014] Example Lens

[0015] Figures 1A-1C illustrate a non-limiting example of an example lens comprising an intraocular lens (IOL.) The lens can vary in configuration and type and can be, for example, an intraocular lens, a contact lens, or any other type of lens.

[0016] Figure 1 A shows a front view of the IOL wherein the front view may be an anterior view. Figure IB shows a back view of the IOL wherein the back view may be a posterior view. Figure 1C shows a side view of the IOL. The IOL includes a central opticalzone 46 (with back side 46b) that provides correction of defocus, astigmatism, and any other correction required of the lens such as spherical aberration. In a non-limiting example, for an IOL optionally using a virtual aperture, the central optical zone diameter is smaller than that of a traditional IOL. This leads to a smaller central thickness which in turn makes the IOL easier to implant and allows a smaller corneal incision during surgery, such as an incision on the order of 2.2 mm. The central optical zone can achieve variable transmissivity of light.

[0017] The IOL optionally includes a virtual aperture 48 that is positioned further peripherally outward relative to the center location of the central optical zone 46. The construction and arrangement of the virtual aperture enable optical rays which intersect the virtual aperture to be widely scattered across a location such as a retina, causing the light to be virtually prevented from reaching detectable levels on the retina. The virtual aperture helps remove monochromatic and chromatic aberrations, yielding high-definition retinal images. The virtual aperture is not necessarily an aperture that blocks rays, but the optical effect is nearly the same on central vision. A bundle of rays incident on the virtual aperture propagate through the virtual aperture and through refraction, diffraction, scattering, reflection, and / or diffusion yield rays which are widely spread out so there is very little contribution to stray light (blurring light) at any one spot on the observation plane. The virtual aperture can be achieved via a surface modification, subsurface modification, or structure added to or positioned relative to the IOL, such as a mask structure. For example, the mask structure can be a ring-shaped structure or any ring-shaped mask that occludes at least a portion of light from passing through the IOL. A modification of the lens (such as the subsurface modification) can occur at least partially pursuant to an in vivo process such as while the lens is implanted in an eye.

[0018] With reference still to Figure 1A, moving peripherally outward from the virtual aperture 48, at least one IOL haptic 50 (with back side 50b) is located on the IOL. The haptic 50 can be formed of one or more arms that extend peripherally outward to define a peripheral most edge of the IOL. In an example, the optical zone has a diameter of 1.5mm. The haptic 50 may define an outermost peripheral region of the IOL. A first plurality of light rays incident on an anterior optical surface of the optical zone can pass through the optical zone to form an image on a retina when the IOL is positioned in an eye, while a second plurality of light rays incident on an anterior virtual aperture surface are dispersed widelydownstream from the IOL towards and across the retina, such that the image comprises an extended depth-of-field and further wherein the virtual aperture reduces monochromatic and chromatic aberrations in the image. The optical zone can comprise at least one of monofocal optics, bifocal optics, trifocal optics and multifocal optics.

[0019] The virtual aperture is optionally connected to the optical zone 46 by a first transition region 47, which is located at a peripheral edge of the optical zone 46 such that the virtual aperture is a first periphery region that surrounds or partially surrounds the optical zone. For example, the virtual aperture can be a ring (such as a diffusive ring) around a central optical zone. The haptic can optionally comprise a second periphery region for positioning the intraocular lens within an eye. The first transition region is located peripherally outward of the optical zone 46. An optional second transition region 49 connects the haptic 50 to the virtual aperture 48. The first transition region 47 and the second transition region 49 are configured to facilitate zero- and first-order continuity of an outer surface of the IOL on either side of the respective transition region. A common way to implement these transition regions is a polynomial function such as a cubic Bezier function. Transition methods such as these are known to those skilled in the art. On the back side of the IOL is a central optic zone 46b, a haptic 50b, and a transition 47b between them. Figures 1A- 1C are not necessarily to scale, and the haptic shape is for illustration purposes only. Other haptic shapes and sizes known to those skilled in the art would be suitable as well. The first and second transition regions are not necessarily present per se in the IOL.

[0020] The IOL has an anterior surface and a posterior surface and the components of the IOL including the optical zone 46, the first transition region 47, the second transition region 49, the virtual aperture 48, the haptic 50 can each have a respective anterior surface and posterior surface. The optical zone 46 has an anterior optical surface that can include at least one multifocal zone and / or a toric region. At least a portion or region of the anterior surface and / or the posterior surface, such as in the region of the virtual aperture or other portion of the IOL, can have a surface contour or shape that achieves a desired or predetermined effect for light passing therethrough. In nonlimiting examples, the surface contour of the anterior surface and / or the posterior surface includes a region with a rippletype contour such as a wave shape or an undulating shape that forms a series of raised and lowered surfaces. The surface contours can achieve various effects with respect to lightpassing through the IOL. For example, the surface contour can achieve a wide or wider spread of stray light depending upon the type of surface contour used. The surface contour can be used to achieve a spread of stray light which is guided away from a focal point of the retina.

[0021] Subsurface Modifications of IOL Including In Vivo Modification

[0022] In an embodiment, at least one region of the IOL, such as the virtual aperture 48 of the IOL, includes at least one subsurface modification (comprising a modification to at least a portion of the internal structure of the IOL such as a modification to a plane or volume of the IOL.) The IOL can include such a subsurface modification as well as an optional external surface feature (such as a shape change or contour on the external surface) on an anterior and / or posterior external surface of the IOL. The subsurface modification is configured to achieve a desired optical effect on light that passes therethrough or otherwise interacts with the subsurface modification, such as to diffuse light, homogenize light, or redirect light for example. The subsurface modification of the IOL provides an alternate, efficient, and repeatable mechanism for at least one region of the IOL to diffuse and / or homogenize light passing therethrough. A degree or level of diffusion and / or homogenization can be tailored to specific requirements by varying the size of laser damage spots or a modified refractive index loci as described below. The spacing or density of the placement of the damage spots or loci can be varied as can a quantity of layers of such damage spots or loci to achieve a desired level of light diffusion. The configuration of the damage spots or loci can also be used to achieve directional control of light such as to steer light in a desired direction. This enables fine tuning and customization of the optical properties of the IOL or of a light diffuser device. The intraocular lens can be part of a system including a laser emitting device configured to emit a laser on a material pursuant to formation of an IOL. A damage spot can be a discrete volume or a collection of volumes of the IOL. A damage spot can also be an opacified zone wherein opacity of the zone is achieved pursuant to the processes described herein. The level of opacity in the zone can vary.

[0023] In any embodiment, the loci can intersect the anterior surface or posterior surface (such as by being positioned tangential to the respective surface.) Or the locican be positioned at any depth relative to the anterior surface or posterior surface including the surface itself.

[0024] The device can achieve diffraction of light passing therethrough in a variety of manners via a diffractive feature contained within or coupled to the device such as the IOL. The diffractive feature is sized to be sufficiently small to create a diffractive effect on light rays interacting with the diffractive feature to widely disburse the light on the retina (or other object.) The diffractive feature can be, for example, a subsurface modification, a prism (or portion thereof such as an edge, point or apex of a prism), a step-shape, a hole or aperture in the IOL, and / or a mask positioned on the IOL. The device can also be configured to achieve diffraction of light via a diffractive feature positioned on or over the device.

[0025] In an embodiment, the subsurface modification(s) are not positioned in the virtual aperture but are rather part of an optical correction zone of the IOL, which may or may not be in the virtual aperture 48 region of the IOL. In another embodiment, the subsurface modifications form a light diffusion region of an IOL or of a light transmitting body or structure that is not an IOL. For example, the features described herein can be used in a light diffuser device that is not an IOL.

[0026] In a first example embodiment of a subsurface modification, a laser is configured to interact with an internal region (i.e., a subsurface region or location) of the IOL to achieve the subsurface modification, such as a modification to the structure of the IOL at the subsurface location. The same laser or different laser can also interact with a surface region of the IOL such that a first laser interacts with a surface region while a second or different laser interacts with a subsurface region. The subsurface region is positioned between at least an anterior surface and a posterior surface of the IOL. In an example, a laser is focused below the surface of the IOL such as to heat the material of the IOL and form a damage region or damage spot located within the material of the IOL at a subsurface location.

[0027] Figure 2 shows a schematic representation of a laser system 1205 that is configured to interact with an IOL 1210 (or with a piece or body of material that is subsequently formed into, placed onto, or otherwise incorporated into the IOL 1210 or that forms a device that is not an IOL such as a light diffuser device.) The laser system 1205 isconfigured to emit a laser 1220 that interacts with the IOL, such as laser 1220 that focuses or otherwise emits a predetermined amount of energy at a subsurface location of the IOL 1210.

[0028] The laser system 1205 is configured to emit the laser 1220 such that the laser 1220 is focused below the surface of the IOL material (such as a glass or polymer material in a non-limiting example) or that is configured to emit a predetermined level of energy at a subsurface location. In an embodiment, the laser is pulsed at a high rate. The laser 1220 creates one or more microscopic damage points inside (i.e. below an external surface of or between an anterior surface and posterior surface of) the IOL material. In an example embodiment, the pulsed laser causes rapid material heating and expansion in a vicinity of the focused laser spot, which create stresses and small-scale fracturing and gas expansion of the material to thereby form a damage spot. The resultant fracture or damage spot can have extremely small dimension (such as on the order of 10s of microns).

[0029] The laser can be moved rapidly and accurately in a lateral X / Y direction while focused at a particular depth (Z-direction) in the material relative to an anterior or posterior external surface. A pattern or array of such damage spots can be formed at the depth. In addition, two or more layers of such damage spots can be formed. The depth of the laser focus spot(s) is accurately and rapidly controlled such as to a depth resolution on a micron scale.

[0030] The laser thus forms a two- or three-dimensional array of damage spots that can be arranged in any of a wide variety of patterns. A two-dimensional array includes two or more damage spots positioned in a common plane. A three-dimensional array includes two or more two-dimensional arrays. Figure 3 shows a schematic representation of a portion of the IOL 1210. It should be appreciated that the portion of the IOL 1210 in Figure 3 is represented as a prism shape for ease of illustration although the shape can vary and is not limited to a prism shape. A two- or three-dimensional array of damage spots 1305 is positioned entirely below an external surface of the IOL 1210. The array includes one or more damage spots. In the illustrated example, the damage spots form a rectangular- shaped array of equidistant damage spots although the shape and spatial arrangement of the array and the damage spots within the array can vary.

[0031] In an example fabrication process for an IOL, the following steps can be performed. First, an IOL is formed such as on a lathe from a plastic (or other material) blank using any well-known process for forming an IOL. The IOL can be machined of any of a variety of materials with an optical zone in the central portion that is configured to enable extended depth of field or monocular focusing. In an embodiment, the IOL is configured having the features described herein with reference to Figures 1A-1C. Next, the virtual aperture can be formed having flat posterior and anterior surfaces (i.e., the outer surface is not machined or otherwise modified) or the anterior or posterior surfaces can be machined to include desired surface features, such as grooves, ridges, waves, ripples, prisms, or any other surface feature. Next, one or more haptics are machined into the substrate blank according to specifications to allow surgical implantation and proper placement in the eye.

[0032] The laser system 1205 is then employed to create a 2 dimensional or 3 dimensional pattern of damage spots within the virtual aperture of the IOL as described above. That is, the damage spots can be aligned within a common plane. In another embodiment, the IOL includes a series of planes arranged to form a three-dimensional array of planes wherein each plane includes one or more damage spots.

[0033] An alignment process and / or system can be employed to properly align the IOL so that the laser damage is aimed correctly and precisely. The two- or three- dimensional array of damage spots is configured to enable a prescribed or desired amount of light transmission and diffusion therethrough. For example, the pattern can be a 5-10 layer pattern of 50 micron spots arranged in a rectangular grid or annular grid with 50 micron spacing between damage spots. The pattern can include an offset between layers such that the gaps are filled in when viewed axially. Since a uniform distribution of damage spots can lead to visual artifacts when implanted in an eye, an exemplary spots pattern employs a pseudorandom placement strategy.

[0034] In a second example embodiment of a subsurface modification, a femtosecond pulsed laser (FSPL) is configured to interact with the IOL (such as by being focused at a subsurface location of the IOL) to modify a refractive index of one or more subsurface locations of the IOL. The femtosecond pulsed laser forms modified loci in the subsurface locations wherein the modified loci have a different refractive index than therefractive index of the material before modification. Different patterns of modified loci can provide selected dioptic power, toric adjustment, and / or aspheric adjustment provided. The refractive index of the modified loci can also be different from a refractive index at a subsurface location that surrounds the modified loci. The different refractive index may be caused by nonlinear absorption of photons resulting from exposure to focused laser light via the femtosecond pulsed laser.

[0035] The femtosecond laser can be specifically tuned based on a material of the lens to achieve a desired optical effect in the lens. Thus, the laser energy and focus of the laser is tailored to the material being modified.

[0036] With reference again to Figure 2, the laser system 1205 can be configured to emit a femtosecond pulsed laser 1220. The femtosecond laser is focused to a point below the surface of the IOL 1210 and is pulsed in a very specific time and intensity profile. The laser can be controlled in the XY plane, such as by using a Galvo positioning controller, which enables very high speed and high accuracy placement of the beam in the XY plane. Additionally, the system can be coupled to or otherwise use an acoustically controlled focusing mechanism enabling very high frequency and very high accuracy focusing control. This enables positioning of the femtosecond laser focus spot at any depth in the substrate and at any XY coordinate with extreme speed and precision.

[0037] The femtosecond laser pulses affect the internal region of the IOL so as to change the refractive index of a specific subsurface region of the IOL and form the loci. The process can be employed with a wide variety of IOL materials including, for example, glass, hydrophobic and hydrophilic acrylics. The mechanism resulting in the change in refractive index is different in each substrate but in all of the substrates mentioned the laser effected area will have a lower refractive index than the surrounding material. The decrease in refractive index may be dependent on various factors including the specifics of the substrate, the intensity and duration of the laser exposure and the thickness of the material. In general, a change in refractive index of about .06 is consistently achievable. For example, if the original hydrophilic acrylic substrate has a nominal refractive index of 1.459 in its fully hydrated configuration, then after laser exposure, the treated areas could have a refractive index as low as 1.399.

[0038] Figure 4 shows a schematic representation of a portion of the IOL 1210. An array of loci 1405 (each having a modified refractive index) is positioned entirely below an external surface of the IOL 1210. The array includes one or more loci. In the illustrated example, the loci form a rectangular- shaped array of equidistant loci although the shape and spatial arrangement of the array and the loci within the array can vary.

[0039] In a sample manufacturing process, the IOL is formed using a lathe to form an IOL with a virtual aperture as described herein. With reference to Figure 2, the IOL is aligned with a femtosecond laser apparatus 1205, which emits femtosecond laser 1210 focused at a subsurface location to create the a desired subsurface pattern of modified refractive index zones to achieve desired diffusion, transmission, and beam steering. The opacity and dimensions of a diffusive portion (such as the virtual aperture) of the IOL can be varied to meet specific performance criteria.

[0040] As mentioned, the laser can be emitted into the IOL pursuant to an in vivo procedure after the IOL has been implanted in the eye. The in vivo modification of the already installed IOL can be performed with or without the use of a stabilizing eyecup, such as is used on a standard ophthalmologic, femtosecond laser machine. An eyecup can be used to stabilize the eye such that the eye does not move and remains fixed during the addition of the virtual aperture or other modification of an optical lens component A user such as clinician can obtain a suitable laser, such as a femtosecond laser, from a supplier. The user may also obtain a suitable software library of laser settings (such as power, focus spot size and shape, duration of pulse, etc.) corresponding to different lens materials that correspond to any of a variety of manufactured IOL’ S. The user then can measure a patient’s current optical characteristics such as pursuant to a pupillometry exam or other exam process to govern the procedure. For example, if the patient has highly mobile expanding / contracting iris, then this would influence the specification of the virtual aperture such as size / diameter and opacity. The patient can be positioned in a suitable treatment location and the laser is emitted through the patient’s cornea to modify the IOL in vivo. The laser emitter is positioned outside the eye. The laser beam passes through the cornea, then through the aqueous humor, and then penetrates the IOL.

[0041] In any embodiment of subsurface modification, multiple layers of the damage spots or loci within an array permits spreading and homogenization of a narrow beam if light that passes into the IOL.

[0042] To the extent the IOL or a portion of the IOL diffuses light, such diffusion can be achieved by various features or techniques associated with the IOL or associated with manufacture of the IOL. Such techniques can include one or more surface modifications of the IOL such a modifying a surface of the IOL using an annular lathe. An annular or non-annular surface modification including a micro-lens can be used. Such modifications can be randomly or pseudo-randomly positioned on the IOL. In another embodiment, a surface of the IOL is abraded (such as via sandblasting, polishing with a specific grit) such as to randomly roughen the surface or to achieve a desired surface roughness. The surface can also be chemically etched or roughened using a laser such as to selectively bum away surface material. Any combination of the aforementioned techniques can also be used.

[0043] In another implementation, diffusion is achieved by modifying an internal aspect of the IOL while leaving an external surface unmodified (or in combination with modification of an external surface of the IOL.) The IOL can incorporate a holographic diffuser wherein a holographic diffuser interference pattern is either sandwiched inside the IOL or formed directly during manufacture of the IOL such as during polymer curing. The IOL may also or alternatively employ a milky material such as a combination of two or more diffusive materials that are homogeneously translucent but not transparent. This can allow for more light attenuation and scattering of light. Subsurface laser engraving can also be employed to achieve diffusion.

[0044] The IOL can be manufactured pursuant to various processes and devices including a lathe, injection molding, a sandwich construction, an ablative laser, a mask laser, and use of a cured polymer. Subsurface laser marking, embossing, a glass embossing plate, silicon molding and surface casting can also be used. Chemical etching can also be used to modify a surface of the IOL.

[0045] In an embodiment, diffusion is achieved by modifying an internal aspect of the IOL while leaving an external surface unmodified, or in combination with modification of an external surface of the IOL. At least one portion of the internal aspect is modified by forming one or more diffusive layers or regions such as by using a laser. Another portion of the internal aspect is modified to form a region of astigmatic correction, such as a toric region, which comprises a bespoke, fine-tuned correction. In an embodiment, an initial lens is used and modified such as pursuant to an in vivo modification. The initial lens prior to modification can vary and can be for example a monofocal bi-convex lens. The lens is modified to so as to have customized specifications particularly targeted to an individual. The specification that is customized can be achieved by forming at least one surface modification of the lens such as the aforementioned toric region. The lens can be modified such as to vary the size (e.g., diameter), shape, transparency, level of opacity, light transmissivity, or other aspect of the lens, such as the optical zone and / or the virtual aperture.

[0046] The lens can be modified to have a subsurface toric region that aligns with an optical zone of the lens to provide an adjustment of lens power. The power profile of the lens can be modified in a bespoke manner. The lens is further modified to have a diffusive layer outside of the optical zone of the lens. The subsurface modification(s) are thus selected to provide an adjusted power profile for the lens.

[0047] Figure 5-7 each show a side, schematic representations of a lens 505 having a front surface 520 and a back or rear surface 525. Each lens 505 has at least one subsurface diffusive layer 510 that has been formed as described above. Each lens also has a customized, subsurface toric region 515. The embodiment of Figure 5 is a monofocal, biconvex configuration. The embodiment of Figure 6 has a front surface 520 that is at least partially flat and the embodiment of Figure 7 has a front surface 520 that is at least partially concave. In the embodiments of Figures 6 and 7, the front surface has a concave central region and lateral outer regions that flare upward which can achieve a naturally vaulted configuration for the lens.

[0048] As mentioned, the toric region 515 is positioned within a range of the optical zone of the lens. The diffusive layer(s) are outsize the range of the optical zone of the lens.

[0049] Pursuant to a method such as described above, a user measures a patient’s current optical characteristics such as pursuant to a pupillometry exam or other exam process to govern the procedure. For example, if the patient has highly mobile expanding / contracting iris, then this would influence the specification of the virtual aperture such as size / diameter and opacity of the lens.

[0050] A biometry of the patient’s eye can also be measured or otherwise obtained. Ocular or optical biometry refers to the measurement of anatomical dimensions of the eye, which include for example corneal curvature (keratometry), axial length, and anterior chamber depth. These measurements can be used to calculate the appropriate power of the intraocular lens (IOL) to be implanted (or an already implanted lens) such as during cataract surgery. Optical biometry can be obtained pursuant to an automated method for measuring the anatomical characteristics of the eye. In an embodiment, partial coherence interferometry is used to obtain the optical biometry of the eye.

[0051] The emmetropic power of the eye is also obtained pursuant to well- known methods. The emmetropic power refers to the perfect or desired correction for distance vision. The measured or otherwise obtained emmetropic power provides a lens starting point or an initial lens specification for the patient. For example, the initial lens can be a monofocal, biconvex lens in a non-limiting example. It should be appreciated that current techniques results in a selection of a lens from a discrete inventory of lens powers wherein the selected lens is not necessarily a lens that best fits the patients needs. Rather, the selected lens may be the closest lens or a best fit lens relative to a desired lens specification based on the available, discrete inventory. Pursuant to the disclosed methods, the selected lens is modified to customize the lens to the patient’s needs, wherein the modification can be in vivo or ex vivo.

[0052] Other patient characteristics are obtained wherein the features may influence the desired, customized lens specification. Such features may include include pupil size, pupillary mobility (e.g., a hypermobile pupil), retinal sensitivity to light, light contrast sensitivity, etc. Thus, measurements are performed to obtain such characteristics including for example pupillary mobility and pupil size (dilated and / or constricted), low contrast sensitivity, corneal aberrations and corneal topography.

[0053] Based on the measured optical characteristics of the patient, one or more target specifications are identified for the lens, wherein the target specifications may be achieved by forming a subsurface modification to the lens. Various aspects of the lens can be modified to achieve a desired, bespoke specification for the lens. Various factors including pupillary mobility can be taken into account pursuant to this method.

[0054] The patient can be positioned in a suitable treatment location and the laser is emitted through the patient’s cornea to modify the lens (e.g., the IOL) in vivo. The modification is selected to achieve a desired specification for the lens based on the aforementioned identification of target specifications for the lens. The laser emitter is positioned outside the eye. The laser beam passes through the cornea, then through the aqueous humor, and then penetrates the IOL to modify a subsurface aspect of the lens. Some example subsurface aspects that can be modified include level of light transmissivity, amount of light diffusion, level of opacity, etc.

[0055] In an embodiment, a profile of the lens optical zone is adjusted or modified. For example, the size (such as diameter), shape (such as circular, oval, non-circular or irregular shape) opacity, light transmissivity and / or other aspect of the lens optical zone and / or virtial aperture may be modified such as by using the laser. If present, a profile of the virtual aperture is also modified to achieve a desired lens characteristic. The virtual aperture itself can also be initially formed in the lens. The modification are configured to account for or otherwise correct one or more corneal aberrations.

[0056] While this specification contains many specifics, these should not be construed as limitations on the scope of an invention that is claimed or of what may be claimed, but rather as descriptions of features specific to particular embodiments. Certain features that are described in this specification in the context of separate embodiments can also be implemented in combination in a single embodiment. Conversely, various features that are described in the context of a single embodiment can also be implemented in multiple embodiments separately or in any suitable sub-combination. Moreover, although features may be described above as acting in certain combinations and even initially claimed as such, one or more features from a claimed combination can in some cases be excised from the combination, and the claimed combination may be directed to a sub-combination or avariation of a sub-combination. Similarly, while operations are depicted in the drawings in a particular order, this should not be understood as requiring that such operations be performed in the particular order shown or in sequential order, or that all illustrated operations be performed, to achieve desirable results. Only a few examples and implementations are disclosed. Variations, modifications and enhancements to the described examples and implementations and other implementations may be made based on what is disclosed.

Claims

CLAIMS1. A method of forming a customized lens, comprising: measuring at least one optical characteristic of a patient including: obtaining a biometry of an eye of the patient; obtaining an emmetropic power of the eye and an emmetropic power correction; obtaining a pupillary mobility of the eye; obtaining a pupil size of the eye; obtaining a low contrast sensitivity of the eye; obtaining a corneal aberration and a corneal topography of the eye; identifying at least one target specification of the lens based on the at least one optical characteristic; providing a lens; and using a laser to modify an aspect of the lens to achieve the at least one target specification.

2. The method of claim 1, wherein the laser forms a virtual aperture in the lens, wherein the virtual aperture surrounds an optical zone of the lens.

3. The method of claim 1, wherein providing a lens comprises selecting a lens from a discrete inventory of lens powers wherein the selected lens is not necessarily a lens that best fits the patient target specification.

4. The method of claim 3, wherein selecting a lens comprises selecting a best fit lens.

5. The method of claim 1, wherein the lens is a monofocal lens prior to modification.

6. The method of claim 1, wherein the laser is emitted through the patient’s cornea to modify the lens in vivo.

7. The method of claim 6, wherein the laser passes through the cornea, then through the aqueous humor, and then penetrates the lens in vivo.

8. The method of claim 1, the laser forms a region of astigmatic correction in the lens.

9. The method of claim 1, wherein the laser forms subsurface light diffusive region in the lens.

10. The method of claim 1, wherein the laser modifies a level of opacity of the virtual aperture.

11. The method of claim 1, wherein the optical characteristic comprises pupillary mobility.

12. The method of claim 1, wherein the optical characteristic comprises retinal sensitivity.

13. The method of claim 1, wherein measuring an optical characteristic comprises performing a pupillometry exam.

14. The method of claim 1, wherein the laser modifies a shape of the optical zone of the lens.

15. The method of claim 14, wherein the laser causes the optical zone to have a non-circular shape.

16. The method of claim 1, further comprising introducing an astigmatic correction to the lens by manipulating a profile of the optical zone.

17. The method of claim 16, wherein manipulating a profile of the optical zone comprises modifying a shape, size, or opacity of the optical zone.

18. The method of claim 16, wherein manipulating a profile of the optical zone comprises modifying a diameter or shape of the optical zone to account for a corneal aberration.

19. The method of claim 1, further comprising introducing an astigmatic correction to the lens by manipulating a profile of the virtual aperture.

20. The method of claim 19, wherein manipulating a profile of the virtual aperture comprises modifying a diameter or shape of the virtual aperture.

21. The method of claim 1, further comprising considering pupillary mobility as a factor in modification of the lens.

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