Abstract:
An intraocular lens designed to separate and prevent fibrosis of the anterior capsular rim with the posterior capsule where it surrounds the optic.

Description:
RELATED APPLICATIONS 
     Various applications related to intraocular lenses are incorporated herein by reference in their entirety. These applications include the following: U.S. Publication No. 20110313519, filed Jan. 31, 2011; U.S. Publication No. 2011/0313524, filed Apr. 22, 2011; U.S. Publication No. 2011/0313525, filed May 19, 2011; U.S. Publication No. 2011/0313526, filed Jun. 7, 2011; U.S. Pat. No. 8,523,942, filed May 15, 2012; U.S. Publication No. 2012/0310344, filed May 16, 2012; U.S. application Ser. No. 13/891,088, filed May 9, 2013; and U.S. application Ser. No. 13/910,076, filed Jun. 4, 2013. 
     BACKGROUND 
     1. Field 
     The present disclosure relates to lenses. 
     2. Description of the Related Art 
     There have been several intraocular lens models designed to allow patients to see at all distances following lens extraction. The most commonly used of these are the multifocal lenses, where the optic in the intraocular lens has two or three focal lengths. These lenses have problems since they require the patient to visually select the lens component&#39;s focal length appropriate to the target in their sight. 
     Since the lenses have multiple focal lengths, only a fraction of the light is available at the focal length being observed. This results in loss of contrast sensitivity. 
     The multiple focal lengths also cause dysphotopsias, especially at night when glare and halos are present. This has led to many multifocal lenses being explanted. 
     Accommodating lenses have also been developed. Constriction of the ciliary muscle during accommodation causes an increase in pressure in the posterior, the vitreous cavity of the eye, and a reduction of the pressure in the anterior chamber of the eye. These pressure changes have been utilized to cause the optic of a flexible intraocular lens to move forwards and backwards in response to the pressure changes. This allows the patient to see seamlessly at all distances. Such designs, however, can be improved. 
     SUMMARY 
     Certain aspects of this disclosure are directed toward a flexible accommodating intraocular lens having plate haptics connected to an optic by connection members. The plate haptics can include one or more anterior ridge protrusions positioned on the plate haptics, for example, extending across a width of the plate haptics. The one or more anterior ridge protrusions can be designed to separate the optic of the lens from the anterior capsule of the human lens capsular bag, into which the lens has been implanted. In certain aspects, the plate haptics can be longitudinally rigid. 
     Certain aspects of this disclosure are directed toward a flexible accommodating intraocular lens having plate haptics connected to an optic by connection members. The intraocular lens can also include paddles. One or more anterior ridge protrusions can be positioned on the paddles, for example, the protrusions can extend across the paddles. The one or more anterior ridge protrusions can be designed to separate the optic of the lens from the anterior capsule of the human lens capsular bag, into which the lens has been implanted. 
     Certain aspects of this disclosure are directed toward a flexible accommodating intraocular lens having plate haptics connected to an optic by connection members. The intraocular lens can also include paddles. One or more anterior ridge protrusions can be positioned on the plate haptics and the paddles. The one or more anterior ridge protrusions can be designed to separate the optic of the lens from the anterior capsule of the human lens capsular bag, into which the lens has been implanted. 
     Certain aspects of this disclosure are directed toward a flexible accommodating intraocular lens having plate haptics connected to an optic by connection members. The intraocular lens can include one or more anterior ridge protrusions positioned adjacent to the connection members. The one or more anterior ridge protrusions can be configured to separate the optic of the intraocular lens from the anterior capsule of the human lens capsular bag into which the lens is implanted. 
     Certain aspects of this disclosure are directed toward a flexible accommodating intraocular lens having plate haptics connected to an optic by connection members. The intraocular lens can include one or more anterior ridge protrusions configured to separate the optic of the intraocular lens from the anterior capsule of the human lens capsular bag into which the lens is implanted. 
     In any of the above-mentioned aspects, the intraocular lens can further include lateral paddle-like extensions. In certain aspects, the plate haptic and lateral paddle-like extensions can have anterior ridge protrusions configured to separate the anterior capsule from the optic of the lens and its connections to the optic. In certain aspects, the anterior protrusions can incline anteriorly between about 5° and 30°, for example, about 15°, 20°, or 25°. 
     In any of the above-mentioned aspects, the anterior ridge protrusions can extend across most of the proximal width of the plate haptic. 
     In any of the above mentioned aspects, the anterior protrusions can extend fully across the plate haptics. 
     In any of the above-mentioned aspects, the connection between the plate haptic and optic can be a flexible stretchable connecting bar or torsion bar. 
     In any of the above-mentioned aspects, the connection between the plate haptic and optic can be a hinge. 
     In any of the above mentioned aspects, the protrusions can provide a space to allow the optic and its connections to the plate haptics to move forward relative to both the proximal and distal ends of the plate haptics. 
     In any of the above mentioned aspects, the connection members can be stretchable. 
     In any of the above mentioned aspects, the one or more anterior ridge protrusions can extend transversely across the width of the plate haptics. 
     In any of the above mentioned aspects, the one or more anterior ridge protrusions can be positioned adjacent to the connection members. 
     In any of the above mentioned aspects, the one or more anterior protrusions can surround the optic by more than 180° of a circumference of the optic 
     In any of the above mentioned aspects, the one or more anterior ridge protrusions can extend along an end of the haptic closest to the optic. 
     In any of the above mentioned aspects, the haptics can include one or more anterior ridge protrusions. 
     In any of the above mentioned aspects, the paddles can include one or more anterior ridge protrusions. 
     Any feature, structure, or step disclosed herein can be replaced with or combined with any other feature, structure, or step disclosed herein, or omitted. Further, for purposes of summarizing the disclosure, certain aspects, advantages, and features of the inventions have been described herein. It is to be understood that not necessarily any or all such advantages are achieved in accordance with any particular embodiment of the inventions disclosed herein. No aspects of this disclosure are essential or indispensable. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Various embodiments are depicted in the accompanying drawings for illustrative purposes, and should in no way be interpreted as limiting the scope of the embodiments. Furthermore, various features of different disclosed embodiments can be combined to form additional embodiments, which are part of this disclosure. 
         FIGS. 1  A &amp; B are a perspective view of various embodiments of an intraocular lens. 
         FIG. 2  is a front elevational view. 
         FIG. 3  is a side elevational view. 
     
    
    
     DETAILED DESCRIPTION 
     For an accommodating lens which functions by moving an optic along the axis of the eye by repeated flexions, flexible materials can be used to form the optic. Silicone is a useful material, since silicone is stretchable and flexible and can be bent or stretched probably several million times without showing any damage. A torsion bar, connecting bar, groove or hinge can be placed across the plate haptic adjacent to the optic, as part of the lens design to facilitate movement of the optic relative to the outer ends of the haptics. (Another material for the lenses is acrylic, although acrylic can fracture if repeatedly flexed.) 
     Unfortunately it has proven to be difficult to show movement of the lens optic, despite many attempts having been made using chemicals in conjunction with “A” (acoustic) scans to stimulate and relax the ciliary muscle. 
     These methods attempting to demonstrate movement have resulted in conflicting results. Some of the studies demonstrate a small forward movement and others a backward movement or no movement at all. 
     Additionally, although the distance and intermediate vision with the currently available accommodating lenses have been excellent, the near vision sometimes requires low power reading glasses to read comfortably. 
     What is useful, are that the designs provide movement of the optic with accommodation. Preferably, such designs provide for favorable vision at far distance, intermediate distance as well as near. Various accommodating lenses are described in: U.S. Publication No. 20110313519, filed Jan. 31, 2011; U.S. Publication No. 2011/0313524, filed Apr. 22, 2011; U.S. Publication No. 2011/0313525, filed May 19, 2011; U.S. Publication No. 2011/0313526, filed Jun. 7, 2011; U.S. Pat. No. 8,523,942, filed May 15, 2012; U.S. Publication No. 2012/0310344, filed May 16, 2012; U.S. application Ser. No. 13/891,088, filed May 9, 2013; and U.S. application Ser. No. 13/910,076, filed Jun. 4, 2013, all of which are hereby incorporated by reference in their entirety and features of such lenses may be included in various embodiments described herein. 
     To insert an artificial lens, the natural lens is initially removed. During this lens extraction, a circular hole is torn in the front of the lens capsule, and the center nucleus and peripheral cortex take out. Subsequently the intraocular lens is inserted into the empty capsular bag, which is attached to the circular ciliary muscle. 
     Healing (fibrosis) then commences. The anterior capsular rim fibroses to the posterior capsule commencing at the periphery or cul de sac of the capsular bag, to cover the peripheral lens structure to fixate and center the lens in place within the bag. 
     The accommodating lenses have generally flat uniplanar plate haptic designs. Plate lenses are manufactured as uniplanar devices; however, the length of the lens from the ends of the two plate haptics (10.5 mm) is slightly longer than the diameter of the capsular bag (10.0 mm). This causes the lens to be vaulted backwards when placed into the capsular bag. 
     Upon accommodation with constriction of the circular ciliary muscle its diameter is reduced, the posteriorly vaulted plate haptic lens is then compressed end-to-end. 
     In some of the accommodating lens designs the plate haptics and optic have been designed to swing forward with the increasing posterior cavity (vitreous cavity) pressure overcoming the end-to-end pressure, which would tend to move the optic posteriorly. 
     In this accommodating lens design, the connection between the optic and the plate haptics is configured to stretch like an elastic band upon end-to-end compression of the plate haptics, with a concomitant increase in vitreous cavity pressure causing the optic to move forward. 
     For this mechanism of action to be successful, space in front of the optic and the component connecting the plate haptic to the optic is desirable, in order to allow forward movement of the optic. 
     Since the hole torn by the surgeon, in the front of the capsular bag is usually 5.0 mm in diameter and the lens optic is also 5.0 mm in diameter, fibrosis of the anterior and posterior components of the capsular bag shrink-wraps the lens to cover the connecting components of the plate haptic to the optic. This prevents or limits the forward movement of the whole lens and the optic. 
     Various embodiments of the invention described herein provide a space in front of the optic and its connections to the plate haptics such that it has room to move forward by stretching of these connections during accommodation, with its concomitant increase in pressure in the posterior chamber (vitreous cavity) of the eye. 
     According to various embodiments of the invention, an accommodating lens comprises a lens with a flexible solid optic attached to which are two or more extended portions, which may be plate haptics, capable of multiple flexes and stretches at their junction with the optic. The lens has fixation and centration features at the distal ends of the plate haptics. There may be a hinge, torsion bar, connecting bar, or groove connecting the plate haptic to the optic. The connection may facilitate the anterior and posterior movement of the optic relative to both the proximal and distal ends of the extended portions, in response to pressure changes in the vitreous (posterior) and anterior chamber cavities within the eye. 
     Various embodiments include a modification of a plate haptic designed with lateral rigid paddles, which along with the proximal end of the plate haptics partially surround the optic through more than 180° of its circumference. These modifications provide a space in front of the optic and its connections to its plate haptics to enable the optic to move forward into the space. Various embodiments of the accommodating intraocular lens may thereby allow the patient to focus automatically and to see seamlessly from distance to near with accommodation. 
     Moreover, a space is provided by adding one or more elevated ridges to the front surface of the plate haptics close to the optic, and/or the rigid paddles that partially surround the optic. The ridges on both plate haptics and/or paddles may together partially extend about the optic across more than 180° of the optics circumference. (The ridge need not be contiguous on each plate haptic but can be provided by two or more spaced apart ridges.) The ridge (or ridges) prevents fusion of the anterior and posterior capsule portions across the elastic stretchable connections between the optic and plate haptics to provide a space in front of the optic and its connections to the plate haptics, thereby allowing it to move forward with accommodation. 
     In certain aspects, there is only one ridge disposed along each plate haptic or paddle. The ridge may be disposed along an edge of the haptic closest to the optic. The ridge may extend across less than about 10% of the haptic, across at least about 10% and/or less than or equal to about 20%, across at least about 20% and/or less than or equal to about 30%, across at least about 30% and/or less than or equal to about 40%, across at least about 40% and/or less than or equal to about 50%, across at least about 50% and/or less than or equal to about 60%, across at least about 60% and/or less than or equal to about 70%, across at least about 70% and/or less than or equal to about 80%, across at least about 80% and/or less than or equal to about 90%, or across at least about 90% and/or less than or equal to about 100% of a width of the haptic. In other aspects, two, three, four, or more ridges are disposed along each plate haptic and/or paddle. The multiple number of ridges may be evenly or unevenly spaced apart across a width of the haptic. The ridges on both plate haptic may together surround the optic by more than 180 degrees or less than 180 degrees. For example, the ridges together may surround less than or equal to about 30 degrees, at least about 30 degrees and/or less than or equal to about 60 degrees, at least about 45 degrees and less than or equal to about 75 degrees, at least about 60 degrees and/or less than or equal to about 90 degrees, at least about 75 degrees and less than or equal to about 105 degrees, at least about 90 degrees and/or less than or equal to about 120 degrees, at least about 105 degrees and/or less than or equal to about 135 degrees, at least about 120 degrees and/or less than or equal to about 150 degrees, at least about 135 degrees and/or less than or equal to about 165 degrees, at least about 150 degrees and/or less than or equal to about 180 degrees of the optic. In certain aspects, a plurality of ridges are disposed along the haptic and/or paddle, each ridge extending across, less than or equal to about 10%, less than or equal to about 5%, less than or equal to about 2%, or less than or equal to about 1% of a width of the haptic. In certain aspects, a plurality of ridges are disposed along the haptic and/or paddle, each ridge extending across, at least about 10%, at least about 5%, at least about 2%, or at least about 1% of a width of the haptic. Ranges within any of these values are also possible. 
     Thus, various embodiments of the present invention are directed to an accommodating lens with an anterior elevated, anterior capsule support ridge, protrusion, or projection, deflecting the anterior capsule portion away from the optic and its connections to the plate haptic. 
     Accordingly, various embodiment of the present invention include features that can provide an improved form of an accommodating lens. 
     In various embodiments, the optic is of a foldable, flexible silicone, acrylic or hydrogel material and the haptic plates are of a foldable material, e.g., silicone, that will withstand multiple foldings without damage. The distal ends of the plate haptics may have flexible T-shaped fixation/centration devices and are contiguous with a chassis designed to make the plates rigid longitudinally but flexible transversely and molded into the plate haptics. The longitudinally rigid chassis may be contiguous with the rigid paddles. 
       FIGS. 1-3  illustrate in detail an embodiment comprising an intraocular lens  1  comprising a flexible solid optic  2 , preferably although not necessarily made of silicone, and portions extending therefrom, plate haptic,  4 , which may be longitudinally rigid and which are capable of transverse flexes without damage and formed, for example, of silicone and polyimide. In some embodiments, the optic  2 , and haptic  4 , are of one piece, and are uniplanar. Additionally, the one or more haptics  4 , are flat on their posterior surface extend distally from opposite sides of the optic  2 . 
     According to various embodiments of the present disclosure, the lens plate haptics can have lateral paddle-like extensions (or projections)  3  extending therefrom. In some embodiments, the proximal plate haptics and the paddles partially surround the optic by more than 180° of the circumference of the optic. The embodiments shown in  FIGS. 1-3  includes an anterior bar-like protrusion (or projection)  5  across the part of the plate haptic  4  proximal to the optic  2 , extending as a ridge along the width of the haptic and/or the rigid paddle-like lateral extensions  3  (see portions  6  of protrusions above paddle-like lateral extensions). The protrusion  5  may also turn to extend longitudinally (e.g., parallel to the y-axis) at the portion  6  thereof over the lateral paddle like extensions  3 . The anterior bar-like protrusion  5  may increase in height as it progresses from a central location proximal the optic laterally towards the lateral paddle-like extensions  3  and/or longitudinally toward the optic  2  and may incline anteriorly and proximally toward the optic  2  from 5° to 30° at the portions  6  above the lateral paddle-like extensions  3 . The anterior bar-like protrusion  5  deflects the anterior portion of the capsule away from the stretchable connecting components  8  and the lens optic  2 , to provide a space to allow the optic to move forward during accommodation. The lens  1  preferably comprises an accommodating intraocular lens. The optic diameter can range from approximately 3.5-8.0 mm and may be 4.5-5.0 mm. The length of the plates from tip to tip may be from 10.0 to 11.5 mm, preferably 10.5 mm, and from loop tip to loop tip from 10.0 to 14.0, preferably 11.5 mm. 
     The haptics  4  preferably are longitudinally rigid plate haptics having arcuate outer edges including loops  7 . The loops  7  when unrestrained are somewhat less curved in configuration as shown in  FIGS. 1  A &amp; B and  2 . The lens  1 , including the optic  2 , haptics  4 , and torsion or connecting bar  8  are preferably formed of a flexible material such as silicone, acrylic, or hydrogel. The loops  7 , chassis  9 , and paddles can be of a material different from the haptics  4  and made of polyimide, prolene, or titanium. The loops  7 , a chassis  9 , and contiguous paddles  3  may be molded into the plate haptics, making the plate haptics  4  longitudinally rigid but flexible transversely. This enables the lens to be folded longitudinally so that it can be inserted into the eye through an incision of 3.0 mm or less. Torsion or connecting bars  8  form elastic stretchable connections between the haptics  4  and the optic  2  such that the optic when subjected to a posterior pressure can move forward at the optic/haptic connection by rotation and stretching of the torsion bars connection. 
     The junction of the posterior surface of the optic  2  to the side of the optic is a sharp edge or junction  11  designed to reduce the migration of cells across the posterior capsule portion of the lens post-operatively and thereby reduce the incidence of posterior capsular opacification and the necessity of YAG posterior capsulotomy. 
       FIGS. 1  A &amp; B and  2  illustrates the haptics  4 , loops  7 , and the connector torsion bars  8  extending from the haptics to the optic  2 . Hard knobs  12  can be provided on the ends of the loops  7  and are designed to fixate the loops  7  in the capsular bag of the eye. 
     The intraocular lenses can be implanted in the capsular bag of the eye after removal of the natural lens. The lenses are inserted into the eye through an incision of 3.0 mm or less from an insertion device folded longitudinally, and placed into the capsular bag through a generally circular opening torn by the surgeon into the anterior capsular portion of the human lens. The outer ends of the haptics, and the loops, are in close proximity with the bag cul-de-sac, and the loops  7  are deflected centrally to size and fixate the lens into the capsular bag. The lenses are implanted in the same manner as described above and as known in the art. 
     In various embodiments, the lens optic and plate material is silicone, and the chassis, loops and paddles are polyimide. 
     As discussed above, in various embodiments, one or more protrusions or projections  5 ,  6  can be provided to reduce the amount of fusion of the anterior and posterior capsule portions across the elastic stretchable connections between the optic  2  and plate haptics  4 . Such a feature can provide a space in front of the optic  2  and its connections to the plate haptics  4 , thereby allowing the optic to move forward with accommodation. The protrusions  5 ,  6  may have various shapes and sizes and may comprise ridges. Such elevated portions  5 ,  6  may reduce the incidence of problematic fusion of the anterior and posterior capsule portions, which inhibits motion of the optic that occurs with accommodation. 
     In various embodiments, the protrusions or ridges  5 ,  6  are longer than high or wide. The protrusions may be narrower at the top than at the base. In some embodiments, an apex or edge may be disposed at the top of the protrusion. 
     In the embodiment shown in  FIGS. 1-3 , for example, the protrusions  5 ,  6  extend most of the transverse dimension of the lens  1  (e.g., parallel to the x-axis). For example, the protrusion  5 ,  6  shown extends substantially the full width in the lateral direction (e.g., parallel to the x-axis) of the haptic  4  and the paddles  3 . In the embodiment shown, the length of the protrusion  5 ,  6  is at least the diameter of the optic  2 , although the protrusions can be shorter. In some embodiments, one or more of the protrusions or ridges  5 ,  6  such as shown in  FIGS. 1-3  comprise multiple shorter segments or protrusions (e.g., 2, 3, 4, 5, 6, 7, 8, 9, 10, or more). Various embodiments can include one or more shorter segments or protrusions, which may be positioned near the connection members  8 , positioned on the haptics, and/or positioned on the paddles. In some instances, the multiple shorter segments or protrusions may be arranged along the transverse dimension of the lens  1 . In various embodiments, the shape of the protrusion  5  is linear or substantially linear. In the embodiments shown in  FIGS. 1-3 , the protrusion  5  is somewhat in the shape of a “C” with a substantial portion extending in the transverse direction (e.g., parallel to the x-axis) and portions  6  at the end extending in the orthogonal, longitudinal direction (e.g., parallel to the y-axis). Other shapes are possible. Additionally, as described above, instead of a single protrusion  5  on each side of the optic  2 , multiple smaller protrusions or segments (e.g., 2, 3, 4, 5, 6, 7, 8, 9, 10, or more) may be used. These protrusions or segments may be separated by spaces. In certain embodiments, a single protrusion has multiple peaks. 
     In various embodiments, the protrusions or projections  5  extend about a large portion of the optic  2  to reduce the incidence of problematic fixation of the capsular bag which inhibits forward motion of the optic with accommodation. The protrusions  5  can be larger or smaller and extend over larger or smaller distances. For example, the protrusions  5  together can extend about at least 50%, 60%, 70%, or 80% of the perimeter (e.g., circumference) of the optic  2 . In some embodiments, however, the protrusions  5  can extend about less than 100%, 90%, 80%, 70%, or 60% of the perimeter (e.g., circumference) of the optic  2  as well. Any combination of these values is possible as are values outside these ranges for some embodiments. Similarly, the protrusions  5  together can extend about at least 180°, 190°, 200°, 210°, 220°, 230°, 240°, 250°, 260°, 270°, 280°, 290°, 300°, 310°, 320°, 330°, 340°, or 350° of the optic  2 . In some embodiments, however, the protrusions  5  can extend about less than 350°, 340°, 330°, 320°, 310°, 300°, 290°, 280°, 270°, 260°, 240°, 230°, 220°, or 210° of the optic  2 . Any combination of these values is possible as are values outside these ranges for some embodiments. As illustrated in  FIGS. 1-3 , multiple protrusions  5  that are not contiguous together extend about a substantial portion of the optic  2  and accordingly, multiple protrusions can be used to provide the above referenced coverage. For example, two protrusions  5  each extending between about 30% to 40% of the perimeter (e.g. circumference) of the optic  2  may be used to cover between about 60% to 80% of the optic. As another example, two protrusions  5  each extending between 120° to 150° about the optic  2  may be used to cover between about 260° to 300° of the optic  2 . Thus, the ranges above may be reduced in half for each of two protrusions, or reduced more if additional protrusions are employed. As discussed above, however, different size protrusions extending about larger or smaller portions of the optics  2  may be used and more than two protrusions may also be used. 
     In various embodiments the protrusions  5  are arranged on opposite sides of the optic  2  as illustrated in  FIGS. 1-3 . However, the arrangement may vary. Moreover, multiple protrusions  5 , for example, 3, 4, 5, 6, 7, 8, 9, 10, or more, may be arranged to reduces the problematic fixation of the capsular bag on the optics  2  and connections with the haptic  4 . 
     The height of the protrusions  5 ,  6  may be between 3%, 4%, 5%, 6%, and 11%, 12%, 13%, 15% of the longitudinal extent of the lens  1  (e.g., in direction parallel to y-axis). Similarly, the height of the protrusions may be between 6%, 8%, 10%, 12% to 20%, or 25% of the diameter of the optic  2 . Larger or smaller heights are possible as well. 
     Conditional language, such as “can,” “could,” “might,” or “may,” unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that certain embodiments include, while other embodiments do not include, certain features, elements, and/or steps. Thus, such conditional language is not generally intended to imply that features, elements, and/or steps are in any way required for one or more embodiments or that one or more embodiments necessarily include logic for deciding, with or without user input or prompting, whether these features, elements, and/or steps are included or are to be performed in any particular embodiment. 
     The terms “approximately,” “about,” and “substantially” as used herein represent an amount close to the stated amount that still performs a desired function or achieves a desired result. For example, the terms “approximately”, “about”, and “substantially” may refer to an amount that is within less than 10% of, within less than 5% of, within less than 1% of, within less than 0.1% of, and within less than 0.01% of the stated amount. 
     Although certain embodiments and examples have been described herein, it will be understood by those skilled in the art that many aspects of the lenses shown and described in the present disclosure may be differently combined and/or modified to form still further embodiments or acceptable examples. All such modifications and variations are intended to be included herein within the scope of this disclosure. A wide variety of designs and approaches are possible. No feature, structure, or step disclosed herein is essential or indispensable. 
     Some embodiments have been described in connection with the accompanying drawings. However, it should be understood that the figures are not drawn to scale. Distances, angles, etc. are merely illustrative and do not necessarily bear an exact relationship to actual dimensions and layout of the devices illustrated. Components can be added, removed, and/or rearranged. Further, the disclosure herein of any particular feature, aspect, method, property, characteristic, quality, attribute, element, or the like in connection with various embodiments can be used in all other embodiments set forth herein. Additionally, it will be recognized that any methods described herein may be practiced using any device suitable for performing the recited steps. 
     For purposes of this disclosure, certain aspects, advantages, and novel features are described herein. It is to be understood that not necessarily all such advantages may be achieved in accordance with any particular embodiment. Thus, for example, those skilled in the art will recognize that the disclosure may be embodied or carried out in a manner that achieves one advantage or a group of advantages as taught herein without necessarily achieving other advantages as may be taught or suggested herein. 
     Moreover, while illustrative embodiments have been described herein, the scope of any and all embodiments having equivalent elements, modifications, omissions, combinations (e.g., of aspects across various embodiments), adaptations and/or alterations as would be appreciated by those in the art based on the present disclosure. The limitations in the claims are to be interpreted broadly based on the language employed in the claims and not limited to the examples described in the present specification or during the prosecution of the application, which examples are to be construed as non-exclusive. Further, the actions of the disclosed processes and methods may be modified in any manner, including by reordering actions and/or inserting additional actions and/or deleting actions. It is intended, therefore, that the specification and examples be considered as illustrative only, with a true scope and spirit being indicated by the claims and their full scope of equivalents.