Patent Publication Number: US-2017354492-A1

Title: Ophthalmic lens inserter apparatus and method

Description:
FIELD OF THE INVENTION 
     The present invention relates generally to ocular surgery. More particularly, the present invention relates to an apparatus and method for inserting an intracorneal lens into a corneal pocket to treat presbyopia. 
     BACKGROUND OF THE INVENTION 
     Presbyopia is the gradual loss of near vision, which often accompanies the aging process and which ultimately results in cataracts. The eyes of a person suffering from presbyopia have a diminished ability to focus on near objects such as books, magazines, or a computer screen. Symptoms of presbyopia can include difficulty reading fine print and blurred vision when transitioning the focus of the eye between near and distant objects. 
     There are several common treatments for presbyopia. A dedicated pair of reading glasses is one such treatment. Reading glasses provide magnification of near objects to provide for improved vision. However, if a person also needs glasses to focus on distant objects switching between reading glasses and distance glasses can be inconvenient. Another treatment is bifocal glasses, which provide a portion of the glasses lens for assisting with distance vision and a portion for assisting with near vision. While bifocals provide a single pair of glasses for both near and distance vision correction, they can cause disorientation. Contact lenses for the surface of the eye have also been developed which provide vision correction for both near and distance vision. Although these treatments provide vision correction for a person suffering from presbyopia, each requires at least one an additional accessory or pair of contact lenses that must be worn or used daily. 
     In efforts to eliminate the limitations of the aforementioned vision correction methods, very small lenses for insertion into the eye, and in particular, a corneal pocket were recently developed. These lenses however, unlike intraocular lenses which are used replace the natural lens after a patient is diagnosed with cataracts, require precise and careful handling to successfully implant the lens without damaging the person&#39;s cornea. The assignee of the present application, for example, has disclosed new devices for the insertion of these lenses in U.S. patent application Ser. No. 13/908,557 (now issued as U.S. Pat. No. 9,017,401) and Ser. No. 15/038,700 from PCT/US14/066540 (published as WO 2015/080933 A1). Those insertion devices disclosed have been able to provide precise positioning while carefully handling the lens for insertion but still can present various sterilization and misalignment challenges. Another prior art device was described in U.S. Pat. App. Pub. No. 2012/0245592 A1, assigned to Neoptics A G. This device is based on a two-part design principle used to minimize handling of the micro-lens by the practitioner prior to insertion. More particularly, the device includes a reusable handle and a pre-load one-off use unit which is used to contain the lens and push off the lens onto the pocket using a slide having a front end that complements the shape of the perimeter of the lens. This device design may compromise the optical properties of the lens when it is pushed off from one side (limiting precision and complicating the insertion procedure), and/or prevent inspection of the lens prior to implantation. 
     While the available prior art seeks to preserve the integrity of the lens and ease insertion, additional further improved devices are desired to overcome one or more of: (A) provide an insertion tool that does not require alignment or assembly of highly delicate parts that are critical to the success of the procedure by the medical practitioner; (B) provide an insertion tool that is completely disposable to prevent re-use of parts that may be contaminated and/or damaged; (C) provide an insertion tool that reduces inadvertent operation by mechanizing the loading and offloading of the micro-lens in a precise manner; (D) provide an insertion tool that allows inspection of a micro-lens by a physician before insertion into a patient&#39;s eye; and (E) provide an insertion tool that doesn&#39;t require the micro-lens to be pushed off a carrier and enables precision placement. 
     Accordingly, it is desirable to provide additional apparatus and methods for inserting a lens into the cornea to improve a patient&#39;s presbyopia. 
     SUMMARY OF THE INVENTION 
     The foregoing needs are met, to a great extent, by the present invention, wherein in some aspects of embodiments of the invention are intended to address one or more of the above noted fundamental problems associated with devices for insertion of a lens into an eye that do not take into account the small and fragile size of intracorneal lenses and the characteristics of corneal pockets. More specifically, an improved lens inserter that can contain the lens throughout an insertion procedure for accurate placement inside a corneal pocket with minimal impact to the surrounding tissue. 
     According to some aspects of the disclosure, an apparatus for inserting a lens into an eye is disclosed. The apparatus for inserting a lens into an eye including a handle having a distal end and a proximal end and an outer wall of the handle defining a lumen extending through the handle; a plunger, including a top tine, a center tine, and a bottom tine, extending movably through the lumen of the handle having a distal end and a proximal end. A distal segment of the plunger extends beyond the distal end of the handle. A first actuator coupled to the plunger configured to provide horizontal sliding movement to the plunger and a second actuator configured to separate an end of the top tine from a lens supporting slot structure provided by one or both of said bottom tine and said center tine are also provided. The center tine can include a pin at an angle that causes it to protrude thru the top tine to secure the lens during insertion in a corneal pocket. 
     In some embodiments, a spring is disposed within the lumen of the handle against which the plunger is biased. Other springs may be included, including, for example, where at least one spring loaded decent configured to signal to a user when the horizontal sliding movement is at a pre-determined position. In addition, at least one spring disposed within the lumen and the second actuator may be included. This spring can be configured to displace, when the second actuator is disengaged, a structure that provides pressure to the top tine. 
     According to additional aspects of the disclosure, the plunger is configured to provide different sliding ranges of motion to the center, top, and bottom tines, via a single movement of the first actuator using mechanical features of the center, top and bottom tines. This may provide, for example, different sliding motion of the center tine in relation to a synchronized motion of the top and bottom tines when the first actuator is moved past an actuation point. In one non-limiting example, the bottom tine may move before one or both of the top and bottom tines when the first actuator is slid towards the proximate end of the handle. 
     Moreover, according to yet additional aspects of the disclosure, the actuation of the second actuator while the first actuator is slid towards/away from the proximate end of the handle can additionally provide articulated motion causing the center tine to remain fixed in relation to the top and bottom tines, allowing for loading of the lens onto a lens supporting structure and for positioning of the lens inside of a corneal pocket, accordingly. 
     There has thus been outlined, rather broadly, certain aspects of the invention in order that the detailed description thereof herein may be better understood, and in order that the present contribution to the art may be better appreciated. There are, of course, additional aspects of the invention that will be described below and which will form the subject matter of the claims appended hereto. 
     In this respect, before explaining at least one aspect of the invention in detail, it is to be understood that the invention is not limited in its application to the details of construction and to the arrangements of the components set forth in the following description or illustrated in the drawings. The invention is capable of aspects in addition to those described and of being practiced and carried out in various ways. Also, it is to be understood that the phraseology and terminology employed herein, as well as the abstract, are for the purpose of description and should not be regarded as limiting. 
     As such, those skilled in the art will appreciate that the conception upon which this disclosure is based may readily be utilized as a basis for the designing of other structures, methods and systems for carrying out the several purposes of the invention. It is important, therefore, that the claims be regarded as including such equivalent constructions insofar as they do not depart from the spirit and scope of the invention. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are included to provide a further understanding of the invention, are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and together with the detailed description serve to explain the principles of the invention. 
         FIG. 1  illustrates a perspective view of an exemplary lens inserter apparatus  100  with relation to an eye  150  in accordance with aspects of the disclosure; 
         FIG. 2  illustrates a magnified view of an articulating plunger end  160  of the lens inserter apparatus  100  of  FIG. 1  proximate to a corneal pocket  155  of an eye  150 ; 
         FIG. 3  illustrates an exploded perspective view of the lens inserter apparatus  100  of  FIG. 1 : 
         FIG. 4A  illustrates a top view of the assembled lens inserter apparatus  100  shown in  FIG. 3 ; 
         FIG. 4B  illustrates a magnified top view of the articulating plunger end  160 ; 
         FIG. 4C  illustrates a magnified side view of the articulating plunger end  160 ; 
         FIG. 5A  illustrates a top view of an exemplary bottom tine  115  of the lens inserter apparatus  100  of  FIG. 1 ; 
         FIG. 5B  illustrates a side view of an exemplary bottom tine  115  of the lens inserter apparatus  100  of  FIG. 1 ; 
         FIG. 5C  illustrates a perspective view of an exemplary bottom tine  115  of the lens inserter apparatus  100  of  FIG. 1 ; 
         FIG. 6A  illustrates a top view of an exemplary center tine  110  of the lens inserter apparatus  100  of  FIG. 1 ; 
         FIG. 6B  illustrates a side view of the exemplary center tine  110  of the lens inserter apparatus  100  of  FIG. 1 ; 
         FIG. 6C  illustrates a magnified section side view of the distal end of the exemplary center tine  110  of the lens inserter apparatus  100  of  FIG. 1 ; 
         FIG. 7A  illustrates a top view of an exemplary top tine  105  of the lens inserter apparatus  100  of  FIG. 1 ; 
         FIG. 7B  illustrates side view of an exemplary top tine  105  of the lens inserter apparatus  100  of  FIG. 1 ; 
         FIG. 7C  illustrates a Perspective view of an exemplary top tine  105  of the lens inserter apparatus  100  of  FIG. 1 ; 
         FIGS. 8A-8G  illustrate configurations provided by the exemplary lens inserter apparatus of  FIG. 1  for loading an intracorneal lens according to aspects of the disclosure; 
         FIGS. 9A-9F  illustrate configurations provided by the exemplary lens inserter apparatus of  FIG. 1  for inserting the intracorneal lens into the corneal pocket according to aspects of the disclosure; and 
         FIG. 11  illustrates a lens transfer tool  1100  which may be implemented with some embodiments according to the present disclosure. 
     
    
    
     The present invention is further described in the detailed description that follows. 
     DETAILED DESCRIPTION OF THE INVENTION 
     The invention will now be described with reference to the drawing figures, in which like reference numerals refer to like parts throughout. Going forward, various aspects of the steering device of the present disclose may be illustrated by describing components that are coupled, attached, and/or joined together. As used herein, the terms “coupled”, “attached”, and/or “joined” are used to indicate either a direct connection between two components or, where appropriate, an indirect connection to one another through intervening or intermediate components. In contrast, when a component is referred to as being “directly coupled”, “directly attached”, and/or “directly joined” to another component, there are no intervening elements present. 
     Relative terms such as “lower” or “bottom” and “upper” or “top” may be used herein to describe one element&#39;s relationship to another element illustrated in the drawings. It will be understood that relative terms are intended to encompass different orientations of steering device in addition to the orientation depicted in the drawings. By way of example, if aspects of steering device shown in the drawings are turned over, elements described as being on the “bottom” side of the other elements would then be oriented on the “top” side of the other elements. The term “bottom” can therefore encompass both an orientation, of “bottom” and “top” depending on the particular orientation of the apparatus. 
     Various aspects of the steering device may be illustrated with reference to one or more exemplary embodiments. As used herein, the term “exemplary” means “serving as an example, instance, or illustration,” and should not necessarily be construed as preferred or advantageous over other embodiments of a steering arm disclosed herein. 
     Glossary 
     In this description and claims directed to the disclosure, various terms may be used for which the following definitions will apply: 
     “Articulated motion”, as used herein, can refer to the different tine parts of the lens inserter device that allow sliding motion up to one or more pre-configured ranges via the first and sometimes second actuator before one or both a positioning signal is provided to the user and/or a rate or degree of movement of one or more part(s) becomes limited in relation to the others. The signal, for example, may include a click for the user to engage/disengage an actuator depending on the position of the device pieces. In some embodiments, the articulated motion can be used to assist the practitioner in the procedure by preventing unintended movement of device parts depending on the procedural stage. 
     “Lens” or “Intracorneal lens”, as used herein, can refer to a biocompatible optical correction device that can be placed inside a corneal pocket of an eye. Typically, the lens can include a micro-lens having a small diameter of, for example, 1 mm-7 mm, and more specifically, preferably a diameter of 2.5 mm-3.5 mm. The lens may include a small generally central hole that can be used to fasten and handle the lens to a tool structure during insertion, facilitate precise positioning of the lens in a corneal pocket, and, in some embodiments, to provide vision correction properties to the user after insertion. 
     “Lens supporting structure”, as used herein, can refer to the structure formed between the bottom tine, and in some embodiments center tine, of a lens inserter device that is used to support a lens during insertion and positioning inside a corneal pocket. In some embodiments, a top tine can be included to further protect top of the lens, and thus the optical properties of the lens during an insertion into a corneal pocket, without damaging the patient&#39;s cornea. 
     The embodiments of the invention and the various features and advantageous details thereof are explained more fully with reference to the non-limiting embodiments and examples that are described and/or illustrated in the accompanying drawings and detailed in the following description. It should be noted that the features illustrated in the drawings are not necessarily drawn to scale, and features of one embodiment may be employed with other embodiments as one skilled in the art would recognize, even if not explicitly stated herein. Descriptions of well-known components and processing techniques may be omitted so as to not unnecessarily obscure the embodiments of the disclosure. The examples used herein are intended merely to facilitate an understanding of ways in which the disclosure may be practiced and to further enable those of skill in the art to practice the embodiments of the disclosure. Accordingly, the examples and embodiments herein should not be construed as limiting the scope of the disclosure, which is defined solely by the appended claims and applicable law. Moreover, it is noted that like reference numerals represent similar parts throughout the several views of the drawings. 
     The ophthalmic lens inserter and method can help enable precise insertion of an intracorneal lens into a pocket in the cornea without compromising the patient&#39;s cornea nor optical corrective properties of the lens during insertion. The corneal pocket can preferably be created by a femtosecond laser or any other precision surgical laser, such as, those used in Lasik™ surgery procedures. According to some aspects, the lens inserter includes a handle and an articulating plunger extending movably through the lumen of the handle. The articulating plunger includes a distal segment that extends beyond the distal end of the handle via at least one actuator coupled to the plunger and configured to provide predetermined movement that can facilitate placement of the lens on a lens supporting structure and insertion and placement of the lens into the corneal pocket. According to other aspects, the lens inserter is made to be disposable by including a limited number of parts and, in some embodiments, having only those parts that are inserted into the cornea and critical to the procedure of a surgical quality steel or include a coating. In some embodiments, for example, the surgical steel parts can be treated, and/or include a coating, to include anti-microbial nano-surface properties. In yet additional embodiments, the part(s) may alternatively or additionally be made to be hydrophobic and/or to have a lower friction coefficient to prevent the tool from sticking and damaging the cornea, for example. In addition, by having the entire lens inserter be disposable, not only can components be made at a lower cost, but also, by enabling disposable lens inserters using, plastics, such as those widely known epoxy compounds, coatings, and the like, the resulting inserter can be lightweight, include personalized features, and eliminate risk of misalignment of parts during sterilization. 
     Referring now to  FIG. 1 ,  FIG. 1  illustrates a perspective view of an exemplary lens inserter apparatus  100  with relation to an eye  150  in accordance with aspects of the disclosure. In particular, the exemplary lens inserter apparatus  100  being a one-time disposable and integrated applicator that can facilitate use according to aspects of the corresponding lens insertion methods described herein. The disposable lens inserter  100  includes a housing  103  enclosing articulating parts functioning via manual operation of one or both a slidable thumb rest  101  and a lens loading actuator  102 . According to some aspects, the manual operation of the slidable thumb rest  101  and lens loading actuator  102  which can enable, as further described below in the description of  FIGS. 8A-8G and 9A-9F , precise and practical insertion of a lens into the cornea  151  of a patient&#39;s eye  150  to correct presbyopia related vision deficiencies. 
     Referring now to  FIG. 2 , a magnified section view of an articulating plunger end  160  of the lens inserter apparatus  100  of  FIG. 1  proximate to a corneal pocket  155  the an eye  150  is depicted. In particular, the section depicts an exemplary corneal pocket  155  made in the patient&#39;s eye  150  in which the microlens is inserted and positioned to provide vision correction. According to some aspects, the articulating plunger end  160  generally being contained, at least in part, inside the housing  103  and being of a surgical quality material can be used to provide support and protection to the lens and its optical properties during insertion and positioning. As previously mentioned, in some embodiments, the parts forming the articulating plunger end  160  may be surgical steel parts with treated surfaces, and/or coated, to include, for example, anti-microbial nano-surface properties, provide low friction coefficients to preserve the integrity of the cornea during insertion of the lens, and/or be hydrophobic to facilitate release of the lens after insertion. Other aspects of the disclosure relating to the structure and operation of the articulating plunger end  160  to be described in relation to the description of the proceeding figures. 
     Moving on to  FIG. 3 , an exploded perspective view of the lens inserter apparatus of  FIG. 1  is depicted. In particular, this figure demonstrates how the different parts are grated and contained by the housing  103  to operate according to aspects of the disclosure. Housing  103  may be formed by a top housing  107  and a bottom housing  104 . In some embodiments, the top housing  107  and bottom housing  104  can contain complementary locking structures  109  to fix each other to the other and enclose the disposable lens inserter components. Moreover, the housing  103  may have an ergonomic shape that allows easy handling of the disposable lens inserter  100 . According to some aspects the housing  103  can include a thumb rest access opening  108  that provides the practitioner to manually operate the slidable thumb rest  101 . In some embodiments, the housing  103  may additionally include a lens loading actuator  102  which can apply pressure to different sections and/or parts of the articulating plunger end  160  during the loading or off-loading of the intracorneal lens  165 . 
     According to yet additional aspects, operation of the articulating plunger end  160  can be a function of the internal structure of the housing  103  and a top tine  105 , center tine  110  and bottom tine  115  moving in relation to each other in predetermined manners. For example, by each of the top tine  105 , center tine  110  and bottom tine  115  attaching to the slidable thumb rest  101 , the different parts can move, in a range limited by their own structural design and that of the housing  103 , to extend out of a distal end of the disposable lens inserter  100 . Structural features of the top tine  105 , center tine  110  and bottom tine  115 , can include, for example, various channels for them to integrate one to another in a pre-determined range of lateral motion, depressions to allow the loading lens actuator to separate or unite the top tine  105  and the bottom tine  115  from one another, stoppers and other locking mechanisms, variations in thickness and/or materials, and the such. 
     The assembled aforementioned parts of the disposable lens inserter  100  can be shown in  FIG. 4A  which illustrates a top view of the assembled lens inserter apparatus  100  of  FIG. 3 . In particular,  FIG. 4  shown the slidable thumb rest  101  slid forward causing the articulating plunger end  160 , shown holding an intracorneal lens  165 , to protrude out of the housing  103 .  FIGS. 4B and 4C  show a magnified top and side view section of the articulating, plunger end  160 . In particular, the magnified top views showing how the intracorneal lens  165  may be contained between the distal ends of the top tine  105  and bottom tine  115 . According to some aspects of the disclosure, an end of the center tine  110  can have an obtuse angle for it to extend upwards and through a section of the top tine  105  to pass thru and secure thereto the intracorneal lens  165  until it is inserted into the corneal pocket  155 . By securing the intracorneal lens  165  through its central hole, the risk of affecting optical properties in the peripheral region of the lens are significantly reduced. (The center tine structure is further explained in detail in relation to  FIGS. 6A-6C .) In some embodiments, the top and bottom surfaces of the intracorneal lens  165  are protected by the leaf-like ends of bottom tine  115  and top tine  105 . In addition or alternatively, in some embodiments, the bottom tine  115  may provide additional support to the intracorneal lens  165  in addition to the center tine  110 . 
     Referring now to  FIGS. 5A-5C , top, side, and perspective views, respectively, of an exemplary bottom tine  115  are shown. In particular, the bottom tine  115  is shown having a distal end  116  including an elongated channel  117 , for the center tine  110  to horizontally traverse therein, and connecting the bottom tine body  119  to the distal bottom leaf-like end  122 . In some embodiments, the distal bottom leaf-like end  122  is configured to support the periphery of the intracorneal lens&#39; bottom surface. As shown, in some embodiments, the bottom tine body  119  can include a bottom tine body&#39;s elongated channel  118  that allows only the center tine  110  to slide therein according to a predetermined range of motion. 
     In accordance with some aspects of the disclosure, the bottom tine  115  can include articulating structural features and attaching features, such as articulating structure  120  and bottom tine slider fastening structure  121 , for controlled movement. For example, in the present embodiment, bottom tine slider fastening structure  121  can be used to attach a corresponding portion  114  (shown in  FIGS. 6A-6C ) of the center tine  110  thereto and/or to the slidable thumb rest  101 . Moreover, the articulating structure  120  can be used to limit movement in relation to the other center  110  and top  105  tines and/or to allow some flexibility to take place when the lens loading actuator  102  is pressed on. 
     Referring now to  FIGS. 6A-6C , top and side views, and a magnified section of the side view, respectively, of the exemplary center tine  110  of the lens inserter apparatus  100  of  FIG. 1  are shown. In particular, the center tine  110  including an intracorneal lens engaging structure  111  located in the center tine&#39;s distal end  113  that is at an obtuse angle in relation to the center tine body  112 . In some embodiments, the intracorneal lens engaging structure  111  is configured to be at an obtuse angle that is greater than 30 degrees and less than about 90 degrees, such that at least a portion of it may protrude thru a central hole of the intracorneal lens  165 . In some embodiments, the lens engaging structure  111  may be generally flexible (e.g. rubber-like structure) or detachably removable to provide for safety precautionary options. In yet additional embodiments, the lens engaging structure  111  may be made of a biodegradable and biocompatible composition and/or be made to rotate about a hinge attached to the center tine. According to some aspects of the disclosure, by having the lens engaging structure  111  provide support from the central hole of the intracorneal lens  165 , the intracorneal lens  165  can be sufficiently engaged thereto upon loading of it and during insertion and alignment inside the corneal pocket  155 , minimizing the risk of compromising the structural optical qualities of the intracorneal lens  165 . As previously mentioned, the center tine  110  can also include a center tine slider fastening structure  114  to attach to one or more of a corresponding structure of the bottom tine  121 , structure of top tine  126 , and the slidable thumb rest  101 . 
     Referring now to  FIGS. 7A-7C , top, side, and perspective views, respectively, of the exemplary top tine  105  are shown. In particular, the top tine  105  including a  106  top tine sliding structural feature  106  on the top tine body  125 . The top tine body  125  leading towards a distal end  123  having a top leaf-like structure for protecting the top surface of the intracorneal lens  165 . In some embodiments, the top line body  125  can include a top tine articulating feature  124  which may be pressed on by the lens loading actuator  102 , for example, to cause the top leaf-like structure to move away from the intracorneal lens  165  and/or one or both of the center tine  110  and the bottom tine  115  when loading or positioning the intraocular lens  165 . The top tine  105  may additionally be fastened to one or both of the center  110  and bottom  115  tines and the slidable thumb rest  101 . With respect to the structural aspects of the tines  105 ,  110 , and  115  and the housing  103 , one skilled in the art will understand from the disclosure that articulated motion of one or more parts may be encouraged or limited by one or more spring loaded parts, detent pins, hand retractable, pins, buspring loaded pins, bspring loaded pins, button handle pins, shackle pins, and the such, such that the disposable lens inserter may function according to the particular aspects of the disclosure and, particularly, as described in  FIGS. 8A-8G  during the loading of the intracorneal lens onto the disposable lens inserter, and  FIGS. 9A-9F  during the insertion of the intracorneal lens into a corneal pocket, as to prevent damage to the patient&#39;s cornea  151 , risk of infection from the procedure, and/or compromising the optical characteristics of the intracorneal lens. 
     Referring back to  FIGS. 8A-8G , disposable lens inserter  100  configurations  800 - 870  according to aspects enabled by the disposable lens inserter that may be used for loading an intracorneal lens onto a lens supporting structure. In particular, at  800  the articulating plunger end  160  of a disposable lens inserter is shown when the slidable thumb rest  101  is pushed forward by a user in anticipation of loading the intracorneal lens. Once the thumb rest  101  reaches a predetermined position for lens loading, the thumb rest  101  can click into a position in which the top tine is pulled back, for example, via some spring loaded detents, to achieve the loading position shown at  810 . At  820 , the intracorneal can be loaded onto a lens engaging feature of the top tine by using a separate transfer tool, such as the transfer tool illustrated in  FIG. 11  at  1100 , which may be used to carefully handle and transport the intracorneal lens  165  from its package  200 . At  840 , the lens loading actuator  102  can be pushed in the direction shown by  102 (A). While holding down the lens loading actuator  102 , the slidable thumb rest  101  can be pushed forward in the direction of  101 (A) to begin sliding the top tine forward as shown at  850 . Continuing to press the lens loading actuator  102 , once the slidable thumb rest  101  is pushed all the way forward, as shown at  860 , the top tine leaf-like structure can cover the top surface of the intracorneal lens, which may again cause the slidable thumb rest  101  to click, indicating to the user that the lens loading actuator  102  can be depressed. Once the lens loading actuator  102  is depressed, the leaf-like structure moves toward the lens as shown at  870 , to decrease the width that must be inserted into the corneal pocket  155 . Maintaining the position shown at  870 , the intracorneal lens can be in a position in the disposable lens inserter for insertion into the corneal pocket  155 . 
       FIGS. 9A-9F  illustrate configurations  900 - 950  according to aspects enabled by the disposable lens inserter that may, be used for inserting and aligning the loaded intracorneal lens in a corneal pocket  155 . In particular, at  900  the disposable lens inserter  100  can be manually handled by a practitioner and guided towards the corneal pocket  155  until at least a portion of the articulating plunger end containing the intracorneal lens is inserted into the corneal pocket  155 , as shown in  910 . Once the articulating plunger end is about a position in which the intracorneal lens  165  is to be located, at  920 , the slidable thumb rest  101  can be pulled back such that the top tine can move away up to a predetermined distance away from the top surface of the intracorneal lens and imparting very minimal force due in part to the structural flexibility (to keep it from causing injury to the cornea). Continuing to slide the thumb rest  101 , at  930 , the top and bottom tines can retract away from the corneal pocket and back into the disposable inserter device  100 . Once the slidable thumb rest  101  is pushed back all the way, the top and bottom tines are fully retracted, as shown at  940 , only the center tine is holding the intracorneal lens allowing for improved visibility and manipulation, thus ultimately more precise alignment. Once the intracorneal lens  165  is aligned, the lens inserter may be removed easily, leaving the lens inside the pocket and aligned, as shown at  950 , due to the obtuse angle of the lens engaging feature and the structural flexibility that the center tine may have. 
     The many features and advantages of the invention are apparent from the detailed specification, and thus, it is intended by the appended claims to cover all such features and advantages of the invention which fall within the true spirit and scope of the invention. Further, because numerous modifications and variations will readily occur to those skilled in the art, it is not desired to limit the invention to the exact construction and operation illustrated and described, and accordingly, all suitable modifications and equivalents may be resorted to, falling within the scope of the invention.