Abstract:
Fluid-filled accommodating intraocular lenses include components enabling the lens to effectively respond to the eye&#39;s natural accommodation process, thereby allowing the patient to visualize over a range of focal distances with minimal complications. Internal components may include, for example, a rigid member that alters optical power of the lens and/or a spanning member extending across the lens that affects the response to accommodative action and/or to filling, or overfilling, of the lens with an optical fluid. Various combinations of internal and external components may be implanted in distinct successive steps or during separate operations to minimize complications and incision size.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims priority to, and the benefits of. U.S. Provisional Patent Application No. 62/159,620, filed on May 11, 2015, U.S. Provisional Patent Application No. 62/159,638, filed on May 11, 2015, U.S. Provisional Patent Application No. 62/159,661, filed on May 11, 2015, and U.S. Provisional Patent Application No. 62/161,302, filed on May 14, 2015, the entire disclosures of which are hereby incorporated by reference. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention relates generally to implantable intraocular lenses for vision correction. 
       BACKGROUND 
       [0003]    The crystalline lens of the human eye refracts and focuses light onto the retina. Normally the lens is clear, but it can become opaque (i.e., when developing a cataract) due to aging, trauma, inflammation, metabolic or nutritional disorders, or radiation. While some lens opacities are small and require no treatment, others may be large enough to block significant fractions of light and obstruct vision. 
         [0004]    Conventionally, cataract treatments involve surgically removing the opaque lens matrix from the lens capsule using, for example, phacoemulsification and/or a femtosecond laser through a small incision in the periphery of the patient&#39;s cornea. An artificial intraocular lens (IOL) can then be implanted in the lens capsular bag (or “capsule bag”)—the sack-like structure remaining within the eye following extracapsular cataract extraction; the lens “capsule” is the thin clear membrane that surrounds the natural crystalline lens—to replace the natural lens. Generally, IOLs are made of a foldable material, such as silicone or uncrosslinked acrylics, to minimize the incision size and required stitches and, as a result, the patient&#39;s recovery time. The most commonly used IOLs are single-element lenses (or monofocal IOLs) that provide a single focal distance; the selected focal length typically affords fairly good distance vision. However, because the focal distance is not adjustable following implantation of the IOL, patients implanted with monofocal IOLs can no longer focus on objects at to close distance (e.g., less than 60 cm); this results in poor visual acuity at close distances. To negate this disadvantage, multifocal IOLs provide dual foci at both near and far distances. However, due to the optical design of such lenses, patients implanted with multifocal IOLs often suffer from a loss of vision sharpness (e.g., blurred vision, halos, glare, and decreased contrast sensitivity). In addition, patients may experience visual disturbances, such as halos or glare, because of the simultaneous focus at two distances. 
         [0005]    Recently, accommodating intraocular lenses (AIOLs) have been developed to provide adjustable focal distances (or “accommodations”), relying on the natural focusing ability of the eye. The term “accommodation” generally refers to the process by which the eye changes optical power to maintain focus at different distances, e.g., as an object recedes or approaches. When the circular ciliary muscle relaxes, the fibrous zonules that connect the muscle to the lens pull on the lens, flattening it to focus on a far object. When accommodating to a near object, the ciliary muscles contract and the lens zonules slacken, allowing the lens to assume a thicker and more convex form. 
         [0006]    AIOLs respond to this ocular behavior in as manner analogous to that of the natural lens. Conventional AIOLs include, for example, a single optic that translates its position along the visual axis of the eye, dual optics that change the distance between two lenses, and curvature-changing lenses that change their curvatures to adjust the focus power. These designs, however, tend to be too complex to be practical to construct and/or have achieved limited success (e.g., providing a focusing power of only 1-2 diopters). One reason for the lack of success is the fact that the AIOL may not respond mechanically the way the natural lens does, or the patient may have an ocular anatomy that requires a non-uniform response by the lens. 
         [0007]    Consequently, there is still a need for AIOLs that provide a high degree of accommodation and provide appropriate focusing power, optically respond correctly to the natural focusing mechanism of the patient&#39;s eye, and which can be easily manufactured and implanted in human eyes. In addition, such AIOLs should respond appropriately to the eye&#39;s natural accommodation mechanism, thereby allowing the patient to experience a range of focal distances with minimal complications. 
       SUMMARY 
       [0008]    In various embodiments, the invention relates to an AIOL that corrects vision and is optically responsive to the natural focusing mechanism of the patient&#39;s eye. The AIOL may include one or more components internal to its “lens” (typically a fluid-fillable reservoir having an exterior flexible membrane) as well as one or more components external to the lens. 
         [0009]    In certain embodiments, an internal component includes, consists essentially of, or consists of a spanning member extending across the lens and that affects the way the device responds to accommodative action and/or to filling, or overfilling, of the lens with an optical fluid. Although internal component(s) may be located in the optical portion of the lens—i.e., a central chamber portion that effects vision correction following implantation—it or they may be configured to avoid interfering with the patient&#39;s vision. A spanning member may act to restrain lens expansion, in the manner of a rope, or may resist lens contraction in the manner of a strut. 
         [0010]    In various other embodiments, an internal component includes, consists essentially of, or consists of an optically shaped rigid component. The rigid component comes into contact with the fluid-filled lens as the eye focuses, causing the fluid-filled lens to change shape. (As used herein, the terms “fluid-filled” and “fluid-fillable” are interchangeable and refer to a lens comprising or consisting essentially of an optically transparent and typically flexible membrane that defines a reservoir fillable by fluid; the fluid and membrane at least partially dictate the optical power of the lens. The lens is not necessarily filled with fluid prior to implantation in a patient&#39;s eye.) Physically the rigid component may be mounted to the lens through a series of flexible coupling members, which allow it to move in the anterior-posterior direction. 
         [0011]    The rigid member may have optical focusing ability such as a lens, or it may have no optical power, as in the case that it is a uniform thickness optically clear spherical (or other shape—e.g. asphetical, toric, multifocal, planar) shell. In all cases, the rigid member is free to disengage from the lens in the axial direction, or to engage and alter the anterior (or posterior) surface of the lens. This movement is actuated either by directly applying pressure to the rigid member or by applying a force to the flexible members. 
         [0012]    In various embodiments, the rigid component is located, either anterior to the anterior surface of the lens (or posterior to the posterior lens surface). The rigid component typically has a surface curvature that differs from curvature of the fluid-filled lens. As it comes into contact with the anterior surface of the fluid-filled lens, it causes the fluid-filled lens to conform to its curvature. Therefore, actuation of the rigid component causes an optical power change in the fluid-filled lens itself due to a curvature change of the anterior surface of the fluid-filled lens. 
         [0013]    In some embodiments, the rigid member is a spherical-shaped portion with a radius of curvature larger than the liquid filled intraocular lens. When the fluid-filled lens contacts the rigid member, it assumes its shape and overall fluid-filled lens power is decreased due to a decrease in optical power from the anterior surface of the lens. When the rigid member is not in contact with the lens, the anterior surface of the fluid-filled lens takes its nominal shape and optical power is higher, corresponding to the accommodated state. 
         [0014]    This contact occurs during the actuation of the rigid member. Initially, the central portion of the rigid member contacts the anterior surface of the fluid-filled lens. Then as it further actuates, it contacts a larger portion of the lens. Finally it contacts the whole anterior surface of the lens. During this process, the optical properties of the fluid-filled lens are altered initially with a change in only the central portion of the lens, extending radially, and finally throughout the whole optical portion of the lens. 
         [0015]    In this manner, the lens may be considered as going from one optical state, S 1 , to a second optical state S 2 , with a continuous transition state mechanically spreading through the lens as the rigid component interacts with the lens. The transition state is characterized by a portion of the light focused in optical state S 1  and a portion of the light focused in optical state S 2 . As the transition occurs the percentage of light in the S 1  state decreases while the percentage in the S 2  state increases. 
         [0016]    This type of lens interacts with the natural accommodation mechanism. First, when the eye is focused at far distance, the ciliary muscles are relaxed and the zonules pull tension on the lens capsule. This tension is applied to the rigid component, causing it to come into contact with the full visual field of the fluid-filled lens. As the eye begins to accommodate, the ciliary muscles contract and move inward, releasing tension on the zonules. As this process occurs, the rigid component moves away from the lens, first releasing contact peripherally, and then centrally as it moves anteriorly. This creates a transition state, based on the periphery of the lens with a radius of curvature corresponding to the natural fluid-filled lens, and the central portion corresponding to the rigid member. When the eye muscles are completely focused on near vision, the lens capsule is relaxed, and the rigid component is no longer in contact with the fluid-filled lens. At this point, the power of the fluid-filled lens is dictated by its natural state. 
         [0017]    In various embodiments, the fluid-filled lens portion of the IOL includes, consists essentially of, or consists of a thin membrane well that is filled through one or more valves. The valve(s) provide fluidic access allowing for both filling and evacuation of the fluid preoperatively, intraoperatively, or postoperatively. The lens portion may be spheric, aspheric, toric, or other non-spherical shape for improved aberration reduction. It may be constructed of a biocompatible material or polymer (parylene, silicone, silicone derivative such as a phenyl substituted silicone, acrylic, polysulfone, hydrogel, collagen, or other suitable material). In certain embodiments the shell includes, consists essentially of, or consists of multiple materials (e.g., layered fluorosilicone and silicone, parylene deposition into silicone, etc.). The filling fluid may be a biocompatible refractive material; examples of these include but are not limited to: an oil, silicone oil, fluorosilicone, phenyl substituted, silicone oil, perfluorocarbon, aqueous material such as a sugar water, vegetable oil, gel, hydregel, nanocomposite, or electrically active fluid. 
         [0018]    The rigid component may be in the shape of a lens that has a minimal power effect on the system. In other embodiments, it may have a non-uniform radius of curvature or points of contact that touch down onto the lens membrane. In yet other embodiments the rigid component may initially come into contact away from the center of the lens. As an example, it may come into contact with the periphery of the lens and then move to the center of the lens. 
         [0019]    The rigid member may have optical properties to correct user vision as well. One example would be to have this stiffer material correct for astigmatism by using a toric shape. 
         [0020]    The rigid member may be made of a biocompatible material such as a polymer (parylene, silicone, silicone derivative such as a phenyl substituted silicones, acrylic, polysulfone, hydrogel, collagen, or other suitable material). In other embodiments, it may have shape memory properties or heat activated materials, which may cause shape changes once exposed to a heat source (i.e., laser or light-emitting diode) once implanted into the capsular bag. This shape change may be used to adjust base power, astigmatism or other user optical needs that may have been preexisting, caused during surgery, or post-surgery effects (i.e. base power drift), in the preferred embodiment this rigid component can be manipulated (folded, split, etc.) to fit through a small incision in order to reduce the incision size used for surgery. One example of a shape-memory material is a shape-memory alloy (e.g., nitinol) frame embedded in a silicone. Shape change of the shape-memory alloy causes a change the shape of the silicone. 
         [0021]    Yet another group of embodiments of the present application relate to IOLs having external components that provide a high degree of accommodation. Two or more haptics, i.e., non-optical, generally peripheral structures that hold the lens in place within the capsular bag inside the eye and transmit force from the eye to the lens. For example, in accordance with various embodiments, the haptics are positioned on the lens such that the changes in the shape of the capsular bag may be directly translated into a shape change of the IOL, thereby enabling the introduction of a desired accommodation to the lens. In addition, embodiments of the invention include additional features on the haptics and/or on the lens such that the distortion of the lens shape alters the optical power of the IOL without degrading the optical qualify of the lens vision zone, e.g., the modulation transfer function (MTF) parameter. 
         [0022]    IOLs in accordance with embodiments of the invention generally include or consist essentially of a soft, deformable shell that accommodates one or more filling fluids (i.e., liquids and/or gases) via one or more valves (e.g., patch valves). The valves are typically accessible from an external portion of the lens with a needle or other fluid line for filling. The valves may be self-sealing, e.g., as described in U.S. patent application Ser. No. 14/980,116, filed on Dec. 28, 2015, the entire disclosure of which is incorporated by reference herein. 
         [0023]    In accordance with various embodiments of the invention, the IOL interacts with the surrounding lens capsule of the eye both to maintain its position therein and to change optical power (i.e., accommodate). In general, interaction with the anterior and posterior lens capsules causes the lens to be centered and stabilized inside the lens capsule. In addition, the lens capsule can transmit force from the ciliary muscles in the eye to the fluid-filled IOL. For distance vision, the zonules apply radial tension along the equator of the lens capsule. This causes tension of the lens capsule to be translated to the fluid-filled IOL, causing the anterior and posterior surfaces thereof to he flattened and the equator of the lens capsule to be expanded. In this state, the IOL has low optical power corresponding to distance vision. During subsequent accommodation, the ciliary muscles contract, releasing tension on the zonules, allowing the lens to relax against the lens capsule; the radius of curvature of the anterior and posterior surfaces of the liquid-filled IOL is reduced, optical power of the lens is increased, and near vision is provided. 
         [0024]    In general, for interaction with the lens capsule, the lens needs to appropriately fill the capsule. In various embodiments, the size (e.g., diameter) of the IOL is over 40% of the lens capsule size, and in certain embodiments over 60% of lens capsule size. In various embodiments, the size of the IOL may be selected, at least in part, by selecting either or both of the size of the lens bag of the IOL and an amount of filling fluid within the IOL. In various embodiments, the IOL interacts with the anterior capsule surface, the posterior capsule surface, or both capsule surfaces during accommodation. 
         [0025]    In certain types of liquid-filled IOLs, the lens preferentially expands along the anterior-posterior (A-P) diameter, with the equatorial portions of the lens expanding less. This may be advantageous, as the lens largely maintains its equatorial shape, which may also improve optical function of the lens. However, matching the lens equator diameter with that of the capsular bag may be more challenging. Thus, in various embodiments of the present invention, the accommodative power of the lens capsule may arise not only from expansion and contraction along the A-P diameter, but also along the equatorial diameter of the IOL. Force-transmitting haptics may be utilized to translate force from the capsule to the IOL (e.g., to the lateral surface thereof). 
         [0026]    In accordance with embodiments of the invention, force-transmitting haptics not only retain the IOL within the capsule, but also effectively transmit the force from the equator of the lens capsule to the side of the lens. This translation causes local motion of the sidewall of the IOL. However, the center of the IOL typically does not translate in the x and y directions, i.e., orthogonal axes in the radial direction of the lens (axes orthogonal to the optical axis of the lens). In various embodiments, the proportion of the outer x-axis and y-axis of the lens remains relatively constant during the accommodation process, thus preserving the original optical shape of the lens during the accommodation process. For example, if the lens is spherical, it may remain substantially spherical throughout the accommodation. 
         [0027]    The force-transmitting haptics in accordance with embodiments of the invention may increase the accommodative amplitude of a fluid-filled IOL. During the accommodated state of the lens, not only does the lens round up, but the equatorial force-transmitting haptic applies a force to the lateral side of the lens, further increasing lens pressure and decreasing lens radius of curvature on the anterior and posterior sides. In the unaccommodated state, the lens capsule applies pressure to the anterior and posterior sides of the lens, flattening it and providing distance vision. In addition, the force-transmitting haptic decreases the force on the lateral side of the IOL, which further decreases pressure and reduces optic power. Further, various embodiments of the invention minimize or substantially eliminate deformation of various portions of the IOL that may result from force applied to the lens periphery by the haptics. For example, embodiments of the invention minimize deformation of the optical regions of the lens and the anterior and posterior peripheral surface portions of the lens. 
         [0028]    The fluid-filled IOLs in accordance with embodiments of the invention differ from conventional solid IOLs. For example, the fluid-filled lens is softer and more flexible than a conventional solid lens, and thus IOLs in accordance with embodiments of the invention utilize different amounts of three transmitted from the capsular bag to introduce similar levels of accommodation. In addition, the optical zone of the fluid-filled lens (i.e., where vision correction takes place and through which the patient sees) may be more vulnerable to degradation of optical quality due to, e.g., wrinkling of the balloon-like lens. Haptics in accordance with embodiments of the invention desirably minimize or substantially eliminate such degradation. Finally, the haptics in accordance with embodiments of the invention have material properties compatible with manufacturing processes utilized to create fluid-filled IOLs. 
         [0029]    In various embodiments of the invention, the haptics transmit force to the lens by rotating relative to the lens. Since the lens itself is typically centered in the lens capsule and fits conformally therewithin, the haptics may transmit to rotational force to the lens itself without causing lens rotation. Rotation of the haptics may result in a large deformation of the side of the lens, and may thereby result in an increase in pressure in the lens during accommodation. The rotational force may act on a greater portion of the side of the lens. The lens rotation may be limited by the curvature of the haptic or angle of the haptic relative to the lens equator surface, which thereby acts as a stop at a point of maximum desired accommodation. 
         [0030]    In various embodiments of the invention, the shape change of the lens caused by the haptic results from an increase in pressure inside the lens. As the haptic moves with the surrounding lens capsule and ciliary muscle movement, it transmits a force to the lens, thereby increasing the pressure inside the lens and increasing the lens power. 
         [0031]    In various embodiments of the invention, a less flexible (or even substantially rigid) annulus is present on (e.g., surrounding) the optical surface of the lens. The annulus acts as a boundary for the anterior and/or posterior surface of the lens when the surface is subjected to force from the haptics. The annulus may constrain the portion of the lens membrane within the annulus to deform uniformly in a spherical manner, regardless of the distribution pattern of haptics disposed around the lens, thereby minimizing or substantially preventing astigmatism of the central optical surface during haptic deformation. 
         [0032]    In yet another embodiment, the components including those described above may be inserted at different times or successive steps to create a multiple component fluid-filled intraocular lens. These fluid-filled lenses can be implanted pre-filled, or filled through a valve after implantation. When implanted in a pre-filled state, the lenses often require a larger surgical incision to fit the large size of the lens. Larger surgical incisions are problematic and require longer healing times. In addition, these incisions may induce postoperative astigmatism, and therefore lower postoperative visual acuity. Therefore there is a need for a multiple component intraocular lens system that allows one or more components to he implanted sequentially through small surgical incisions. 
         [0033]    The separate components may be mechanically coupled, or have a fluid coupling. In certain embodiments of the invention, one or more portions of the lens come into fluidic contact with another component or component&#39;s contents during inflation. The components have interlocking portions which engage during filling and an interface, such as a valve, between the two components is activated or opened during the inflation process. Activation may occur from increased pressure between the two components causing a cracking pressure, or by pushing one component into a valve cracking feature. In other embodiments the valve is cracked after inflation by using a remote energy source such as a laser (e.g. Nd:YAG laser, femtosecond laser, picosecond laser, thermal or other optical source). 
         [0034]    By breaking down a complex lens into multiple smaller components, the lens may be implanted into the eye through small surgical incisions. In addition, portions of the lens may be removed and/or exchanged without altering other portions of the lens. This technique is also an advantage when piggybacking lenses inside the eye. 
         [0035]    By using a modular component-based implant, it is possible to adjust certain portions of the system individually. As an example, the power of a lens may be adjusted without affecting the haptic portion. In other embodiments, the lens may be adjusted by adjusting the haptic portion of the lens. The haptic portion of the lens may be used to translate the lens portion relative to the eye for better centration, move the lens portion in an anterior or posterior direction, or tip/tilt the lens portion for improved optical resolution, it may also be used to rotate the lens, for example, rotating a toric lens for better angular alignment of the lens with the cornea. 
         [0036]    A separate component of the lens may be used to restore or maintain the natural lens capsule configuration, to space the lens capsule from the lens component and to prevent local inflammatory or immune reaction from interfering with the lens component of the multiple component IOL. This includes preventing lens epithelial cells from clouding the lens component or interfering with lens actuation as in the case of an accommodating intraocular lens (AIOL). 
         [0037]    In certain embodiments of the invention, one portion of the lens is implanted into the capsule to maintain shape. Before, after, or during implantation, the lens capsule may be modified for better postoperative outcomes. Modification may include using a fluid such as hypotoric aqueous solution (e.g. saline, water, dextrose) or cytotoxic solution (local chemotherapy such as methotrexate, etc. . . . ) to eliminate remnant cells in the lens capsule. Other types of modification include removing portions of the lens capsule, while the lens capsule is supported by this surrounding/haptic component of the IOL. 
         [0038]    In an aspect, embodiments of the invention feature an intraocular lens implantable into the capsular bag of an eye. The intraocular lens includes or consists essentially of a flexible membrane defining an interior region for accepting a filling fluid and providing an optical correction to vision and, extending from an outer surface of the flexible membrane, a plurality of haptics for retentively engaging surrounding tissue and transmitting force from the capsular bag to the flexible membrane, thereby altering a shape of at least a portion of the flexible membrane and an optical power of the intraocular lens. The haptics do not coincide with (or overlap) an optical axis of the lens. 
         [0039]    Embodiments of the invention may include one or more of the following in any of a variety of combinations. One or more, or even all, of the haptics may be elongated and/or curved. One or more, or even all, of the haptics may be shaped as an S or a partial circle (e.g., half-circle). One or more, or even all, of the haptics may be circular. The plurality of haptics may include, consist essentially of, or consist of four or more haptics. The haptics may be distributed around the flexible membrane (e.g., around an equator of the flexible membrane) substantially symmetrically. The haptics may be asymmetrically distributed around the flexible membrane (e.g., around an equator of the flexible membrane). A spacing around the flexible membrane (e.g., around an equator of the flexible membrane) between each pair of the haptics may be approximately equal. The intraocular lens may include a ring disposed around a periphery of the flexible membrane (e.g., around an equator of the flexible membrane). The ring may define a plurality of apertures, each haptic extending through an aperture. The ring may prevent direct transmission of force from the capsular bag to the flexible membrane. The intraocular lens may include a reinforcing pattern disposed on an inner surface and/or the outer surface of the flexible membrane. The reinforcing pattern may be less flexible than the flexible membrane. The reinforcing pattern may be disposed outside an optical zone of the intraocular lens (i.e., disposed outside of the portion of the lens through which vision of the patient typically occurs). The thickness of all or a portion of the reinforcing pattern is greater than a thickness of the flexible membrane. The reinforcing pattern may have a polygonal shape with a plurality of vertices. One or more, or even all, of the haptics may each extend from the flexible membrane at one of the vertices. The reinforcing pattern may be outside the optical axis. The reinforcing pattern may include, consist essentially of, or consist of straight segments that curve under accommodation. The segments may curve away from the optical axis under accommodation. One or more, or even all, of the haptics may each include, consist essentially of, or consist of a hollow tube. 
         [0040]    In another aspect, embodiments of the invention feature an intraocular lens implantable into the capsular bag of an eye. The intraocular lens includes or consists essentially of a flexible membrane defining an interior region for accepting a filling fluid and providing an optical correction to vision, and disposed on an outer surface of the flexible membrane, a plurality of haptics for transmitting force from the capsular bag to the flexible membrane, thereby altering a shape of at least a portion of the flexible membrane and an optical power of the intraocular lens. Each haptic is a solid curved segment extending along a portion of the outer surface of the flexible membrane away from an optical axis thereof. The haptics are spaced around the outer surface of the flexible membrane to define gaps therebetween in a relaxed state of the intraocular lens, a size of each gap decreasing in an accommodated state of the intraocular lens. 
         [0041]    Embodiments of the invention may include one or more of the following in any of a variety of combinations. The haptics may surround the optical axis of the flexible membrane. The plurality of haptics may include, consist essentially of, or consist of four or more haptics. In the relaxed state of the intraocular lens, the sizes of the gaps may be substantially equal. The gaps may decrease to approximately zero (i.e., the haptics may contact each other) in an accommodated state of the intraocular lens. The haptics may be attached to the flexible membrane by an adhesive. 
         [0042]    In yet another aspect, embodiments of the invention feature an intraocular lens implantable into the capsular bag of an eye. The intraocular lens includes or consists essentially of a flexible membrane defining an interior region for accepting a filling fluid and providing an optical correction to vision, an elastic ring surrounding and spaced apart from the flexible membrane, the elastic ring being configured to accept force from the capsular bag and configured to retentively engage surrounding tissue, and extending from the elastic ring to the flexible membrane, a plurality of haptics for transmitting force from the elastic ring to the flexible membrane, thereby altering a shape of at least a portion of the flexible membrane and an optical power of the intraocular lens. 
         [0043]    Embodiments of the invention may include one or more of the following in any of a variety of combinations. One or more, or even all, of the haptics may each include, consist essentially of, or consist of a plurality of segments each having a first end connected to the elastic ring and a second end connected to the flexible membrane. One or more, or even all, of the segments may be linear. For one or more, or even, all, of the haptics, a spacing between the first ends of the segments may be larger than a spacing between the second ends of the segments. For one or more, or even all, of the haptics, the second ends of the segments may meet at a common point on the flexible membrane. 
         [0044]    In another aspect, embodiments of the invention feature an intraocular lens that includes, consists essentially of, or consists of a membrane defining a central chamber for containing an optical fluid and a spanning member extending between opposed areas of an internal surface of the membrane. When the central chamber is filled, it provides vision correction when implanted in a patient&#39;s eye, the central chamber having an optical axis extending through a vision-correcting optical zone of the central chamber. The spanning member resists expansion and/or collapse of the central chamber. 
         [0045]    Embodiments of the invention may include one or more of the following in any of a variety of combinations. The spanning member may be elastomeric so as to restrain expansion of the membrane but not collapse thereof. The spanning member may be stiff so as to restrict both collapse and expansion of the membrane. The spanning member may include, consist essentially of, or consist of a spiral spring. At least a portion of the spanning member may extend along an optical axis of the lens. At least a portion of the spanning member may be continuous and solid. At least a portion of the spanning member may be tubular. The lens may have an optical zone. At least a portion of the spanning member may have a diameter larger than a diameter of the optical zone of the lens. The membrane may be at least partially filled with a first optical fluid. The spanning member may be at least partially filled with a second optical fluid different. The first and second optical fluids may be different. The first and second optical fluids may be the same. The membrane may be at least partially filled with an optical fluid, and the spanning member may be permeable to the optical fluid. The spanning member may join the internal surface of the membrane at first and second opposed ends. Each of the ends may have at least one shaped terminal head member with a distal region attached to or integral with the interior surface of the membrane. At least one of the head members may have a terminal surface area sufficiently small relative to a surface area of the interior surface of the membrane to permit the membrane to bulge upon overfilling with an optical fluid. At least one of the head members may have a terminal surface area sufficiently large relative to a surface area of the interior surface of the membrane to resist bulging of the membrane upon overfilling with an optical fluid. At least one end of the spanning member may include, consist essentially of, or consist of a plurality of branches each terminating in a head member with a distal region attached to or integral with the interior surface of the membrane. At least one of the head members may have a substantially symmetric terminal surface. The terminal surface may be round. At least one of the head members may have a substantially asymmetric terminal surface. The terminal surface may include, consist essentially of, or consist of a plurality of radial projections. The exterior surface of the membrane overlying at least one of the head members may have a plurality of radial grooves. The spanning member may be colored. At least a portion of the spanning member may have a color different from a color of the flexible membrane. 
         [0046]    In yet another aspect, embodiments of the invention feature a method of correcting a patient&#39;s vision. A fluid-fillable and/or fluid-filled deformable lens having an optical axis is installed within the patient&#39;s capsular bag following removal of the natural lens therefrom. A rigid member is installed along the optical axis within the patient&#39;s capsular bag. Actuation of the rigid member causes it to releasably contact a portion of a surface of the deformable lens and thereby alter an optical power of the deformable lens. The contacted surface has an area dependent on a degree of the actuation. 
         [0047]    Embodiments of the invention may include one or more of the following in any of a variety of combinations. At least a portion of the rigid member may be substantially planar. At least a portion of the rigid member may have a thickness larger than a thickness of a membrane of the deformable lens. At least a portion of the rigid member may have optical power. At least a portion of the rigid member may have no optical power. At least a portion of the rigid member may be a segment of a sphere having as radius larger than a radius of the deformable lens. The rigid member may be actuated by far-distance focus of the patient&#39;s eye. The rigid member may be anchored to the capsular bag by one or more flexible coupling members. At least a portion of the rigid member may be polymeric. At least a portion of the rigid member may include, consist essentially of, or consist of a shape-memory material (e.g., a shape-memory alloy). At least a portion of the rigid member may have a shape. The portion of the deformable lens in contact with the rigid member may assume the shape of the rigid member. The rigid member may be deformable so that the portion of the deformable lens in contact with the rigid member only partially assumes the shape of the rigid member. 
         [0048]    In another aspect, embodiments of the invention feature a combination that includes, consists essentially of, or consists of a focus-altering component and a fluid-fillable and/or fluid-filled deformable lens having an optical axis and sized to fit within a patient&#39;s capsular bag. The focus-altering component includes, consists essentially of, or consists of a rigid member having an interaction surface and, joined thereto, a plurality of flexible coupling members configured for anchoring the focus-altering component to the capsular bag so as to permit interaction within the capsular bag between the rigid member and the deformable lens. 
         [0049]    Embodiments of the invention may include one or more of the following in any of a variety of combinations. At least a portion of the rigid member may be substantially planar. At least a portion of the rigid member may have a thickness larger than a thickness of a membrane of the deformable lens. At least a portion of the rigid member may have optical power. At least a portion of the rigid member may have no optical power. At least a portion of the rigid member may be a segment of a sphere having a radius larger than a radius of the deformable lens. The coupling members may be configured to permit the interaction in response to far-distance focus of the patient&#39;s eye. At least a portion of the rigid member may be polymeric. At least a portion of the rigid member may include, consist essentially of, or consist of a shape-memory material (e.g., a shape-memory alloy). At least to portion of the rigid member may have a shape. The portion of the deformable lens in contact with the rigid member may assume the shape of the rigid member. The rigid member may be deformable so that the portion of the deformable lens in contact with the rigid member only partially assumes the shape of the rigid member. 
         [0050]    In yet another aspect, embodiments of the invention feature a combination that includes, consists essentially of, or consists of a retaining structure and a fillable intraocular lens which, when tilled with an optical fluid, has an optical power, an optical axis and a matable feature. The retaining structure includes, consists essentially of, or consists of (i) a central gap portion comprising a matable feature complementary to the matable feature of the lens, whereby mating of the matable features couples the lens to the retaining structure for retention of the lens within the central gap portion, and (ii) peripheral means for stabilizing the retaining structure within the capsular bag of a patient. 
         [0051]    Embodiments of the invention may include one or more of the following in any of a variety of combinations. The retaining structure may have a ring configuration. The retaining structure may have as peripheral edge. The stabilizing means may include, consist essentially of, or consist of a plurality of haptics projecting from the peripheral edge of the retaining structure. The retaining structure may be tillable with a fluid. The retaining structure may be at least partially filled with a fluid. The fluid may be a liquid and/or a gas. One of the matable features may include, consist essentially of, or consist of a tab, and the other matable feature may include, consist essentially of, or consist of a recess. The matable features may be roughened or modified surfaces providing a mechanical interface when in contact. The matable features may be frictional surfaces providing a mechanical interface when in contact. The combination may include means for establishing fluid communication between the lens and the retaining structure. The means for establishing fluid communication may include, consist essentially of, or consist of valve portions on the lens and on the retaining structure. The lens may include a plurality of haptic members and may be coupled to the retaining structure via the haptic members. The lens may not be in contact with the retaining structure. The retaining structure may include, consist essentially of, or consist of a plurality of discrete fillable chambers. The retaining structure may include, consist essentially of, or consist of a secondary lens. The combination may include means facilitating alignment of the intraocular lens and the secondary lens. 
         [0052]    These and other objects, along with advantages and features of the present invention herein disclosed, will become more apparent through reference to the following description, the accompanying drawings, and the claims. Furthermore, it is to be understood that the features of the various embodiments described herein are not mutually exclusive and may exist in various combinations and permutations. As used herein, the terms “about,” “substantially,” and “approximately” mean ±10% (e.g., by weight or by volume), and in some embodiments, ±5%. Reference throughout this specification to “one example,” “an example,” “one embodiment,” or “an embodiment” means that a particular feature, structure, or characteristic described in connection with the example is included in at least one example of the present technology. Thus, the occurrences of the phrases “in one example,” “in an example,” “one embodiment,” or “an embodiment” in various places throughout this specification are not necessarily all referring to the same example. Furthermore, the particular features, structures, routines, steps, or characteristics may be combined in any suitable manner in one or more examples of the technology. The headings provided herein are for convenience only and are not intended to limit or interpret the scope or meaning of the claimed technology. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0053]    In the drawings, like reference characters generally refer to the same parts throughout the different views. Also, the drawings are not necessarily to scale, with an emphasis instead generally being placed upon illustrating the principles of the invention. In the following description, various embodiments of the present invention are described with reference to the following drawings, in which; 
           [0054]      FIG. 1A  is a sectional plan view of a fluid-filled intraocular lens having an internal spanning component in accordance with various embodiments of the invention. 
           [0055]      FIG. 1B  is a sectional plan view illustrating the effect of the spanning component shown in  FIG. 1A  upon contraction of the ciliary muscles and consequent expansion of the lens in accordance with various embodiments of the invention. 
           [0056]      FIG. 2A  is a sectional plan view of a fluid-filled intraocular lens having an internal spanning component with a larger attachment surface in accordance with various embodiments of the invention. 
           [0057]      FIG. 2B  is a sectional schematic of a fluid-filled intraocular lens having an internal spanning component with a diameter larger than the optical zone of the lens in accordance with various embodiments of the invention. 
           [0058]      FIG. 3  is a sectional plan view of a fluid-filled intraocular lens having an internal spanning component with a non-unitary attachment surface in accordance with various embodiments of the invention. 
           [0059]      FIG. 4A  is an elevational view along the optical axis, and  FIG. 4B  is a sectional view taken along the line  4 B- 4 B, of a fluid-filled intraocular lens in accordance with various embodiments of the invention. 
           [0060]      FIG. 5A  is an elevational view along the optical axis, and  FIG. 5B  is a sectional view taken along the line  5 B- 5 B, of another configuration of a fluid-filled intraocular lens in accordance with various embodiments of the invention. 
           [0061]      FIG. 6  is an elevational view along the optical axis of the embodiment shown in  FIGS. 4A and 4B , but with grooves along the region where the spanning member joins the lens membrane in accordance with various embodiments of the invention. 
           [0062]      FIGS. 7A-7D  are schematic illustrations of an intraocular lens transitioning from near vision to far vision in accordance with various embodiments of the invention. 
           [0063]      FIGS. 8A and 8B  are schematic sectional views (with the optical axis in the plane of the figure) of an intraocular lens having a rigid member not coupled to the lens during actuation inside the capsular bag in accordance with various embodiments of the invention. 
           [0064]      FIGS. 9A and 9B  are schematic sectional views (with the optical axis in the plane of the figure) of an intraocular lens having a rigid member coupled to the lens during actuation inside the capsular bag in accordance with various embodiments of the invention. 
           [0065]      FIGS. 10A-10B  are schematic views of intraocular lenses with haptics in accordance with embodiments of the invention; 
           [0066]      FIGS. 11A-11C  are schematic views of intraocular lenses with haptics in accordance with embodiments of the invention; 
           [0067]      FIGS. 12A-12D  are schematic views of intraocular lenses with haptics and a protective ring in accordance with embodiments of the invention; 
           [0068]      FIGS. 13A-13D  are schematic views of intraocular lenses with haptics and a reinforcement pattern in accordance with embodiments of the invention; 
           [0069]      FIGS. 14A-14D  are schematic views of intraocular lenses with partial-ring haptics in accordance with embodiments of the invention; and 
           [0070]    FIGS,  15 A- 15 C are schematic views of intraocular lenses with haptics surrounded by an elastic ring in accordance with embodiments of the invention. 
           [0071]      FIG. 16A  is a schematic illustration of a central fluid-fillable lens and a solid haptic peripheral component of a multiple-component intraocular lens in accordance with embodiments of the invention. 
           [0072]      FIG. 16B  is a schematic illustration of the fluid-fillable lens and haptic peripheral component of  FIG. 16A  in assembled form in accordance with embodiments of the invention. 
           [0073]      FIGS. 17A-17D  are schematic illustrations of a multiple-component intraocular lens having a central fluid-fillable lens and a fluid-fillable haptic peripheral component in accordance with embodiments of the invention. 
           [0074]      FIGS. 18A-18C  are schematic illustrations of an exemplary coupling mechanism to provide fluidic continuity between two components of an intraocular lens after implantation in accordance with embodiments of the invention. 
           [0075]      FIGS. 19A-19C  are schematic illustrations of an exemplary coupling mechanism to provide fluidic continuity between two components of an intraocular lens after implantation in accordance with embodiments of the invention. 
           [0076]      FIGS. 20A and 20B  are schematic illustrations of an intraocular lens with a surrounding haptic component in accordance with embodiments of the invention. 
           [0077]      FIGS. 21A and 21B  are schematic illustrations of an intraocular lens having haptic components with filling valves connected to a central fluid-fillable lens in accordance with embodiments of the invention. 
           [0078]      FIGS. 22A-22C  are schematic illustrations of an intraocular lens having a piggyback lens component in accordance with embodiments of the invention. 
       
    
    
     DETAILED DESCRIPTION 
       [0079]    A. Internal Components 
         [0080]      FIG. 1  depicts a liquid-filled accommodating IOL  100  having an interior region  102 , which includes an optical zone  104  through which the optical axis passes as indicated. The lens is defined by a membrane  106 , which may be made of a flexible polymeric material such as silicone or parylene. The membrane has an anterior side  106   a  and a posterior side  106   p , which faces the patient&#39;s retina following implantation. A valve  110  facilitates filling and, in some embodiments, refilling of the AIOL  100  with an optical fluid (e.g., silicone oil). The lens  100  is surrounded by the capsular bag  115 , which is itself bound to the zonules  118  on opposed sides. A spanning member  120  extends along the optical axis and joins the interior surface of the membrane  106  at opposed points. One or both of the ends  125   a,    125   p  of the spanning member  120  may be shaped to produce a desired mechanical response as the lens  100  is stretched or released by the zonules  118  and/or is filled with an optical fluid. In some embodiments, the spanning member  120  acts as a string or rope, limiting the expansion of the membrane  106  when the zonules  118  tighten and/or the lens is overfilled. In such embodiments, the spanning member  120  may fabricated from a malleable polymer with adequate tensile strength to avoid breakage and a sufficient Young&#39;s modulus to avoid stretching in response to accommodation-induced stress. For example, the spanning member may be polyester, polyethylene, PTFE, silicone, or parylene. 
         [0081]    In other embodiments, the spanning member  120  is a spring in tension with a predefined spring constant, k; as a result, the spanning member maintains a length dimension of L with an allowable expansion of ΔL, thereby limiting the amount of curvature change of the anterior and posterior membrane surfaces  106   a,    106   p . In this case, the spanning member may be an elastomeric polymer. i.e., a polymer exhibiting viscoelasticity and a low Young&#39;s modulus. Examples include polyurethanes and polybutadiene, and various other polymers. Alternatively, the spanning member  120  may be a spiral spring. 
         [0082]    The spanning member  120  is preferably optically clear and/or slender enough to negate any effect on vision. Optical clarity may be obtained by index-matching the spanning member  120  to the fluid filling the lens  100  in order to reduce light scatter and improve optical properties. Alternatively or in addition, the spanning member  120  may be permeable to the filling fluid, with the filling fluid altering the refractive properties of the spanning member  120 . For example, the spanning member may be a permeable polymer or shaped as a tube that is filled with an optical fluid (which may have the same or a different refractive index from that of the lens filling fluid). As depicted in  FIG. 2B , the tube may, for example, have an internal diameter greater than that of the optical zone of the lens  200 . The tube may include one or more apertures to allow the influx and egress of fluid from the interior of the lens  200  into the tube. Alternatively, the tube may include one or more valves that facilitate separate injection and removal of fluid in a fashion similar to that of the lens  200 . The fill volume within the tube may be further adjusted to define various curvatures and profiles (e.g., to correct astigmatism and other asymmetric optical anomalies) within the optical zone. The tube desirably contributes no optical aberrations to affect visual acuity. 
         [0083]    More generally, all or part of the spanning member  120  may be colored to facilitate visual detection thereof once the lens is implanted, signaling incorrect fill volume and/or the need for fill volume adjustment. The ends  125   a,    125   p  of the spanning member  120  may be joined to the interior surface of the membrane  106  in any suitable manner, e.g., by an adhesive such as epoxy or by heat, or the spanning member  120  may instead be co-molded with the membrane so as to be an integral part of the lens structure. Although the spanning member  120  is shown as a solid structure, in some embodiments it is molded as a spiral spring from a polymer having a desired stiffness. 
         [0084]    The profiles of the ends  125   a,    125   p  influence the mechanical response of the lens  100  not only to natural ocular accommodation but also to filling of the lens  100  via the valve  110 . With reference to  FIG. 1B , when the volume of optical fluid in the lens  100  exceeds its nominal volume, increasing internal pressure causes the anterior and posterior surfaces  106   a,    106   p  to bulge in a manner dependent on the elasticity of the membrane  106 , the physical boundary conditions imposed by surrounding tissue structures, and the profile of the ends  125   a,    125   p.  In the case of the lens  100 , the ocular anatomy may permit the emergence of a circular anterior bulge  150 . In some embodiments, this bulge may be small enough to avoid affecting vision but large enough to increase adhesion to the lens capsule  115 ; but if the lens membrane  106  is sufficiently yielding, the bulge  150  may contribute to the optical correction provided by the lens  100 . 
         [0085]    To reduce or avoid the emergence of a bulge, the profile of the spanning-member ends can be altered, as shown in  FIG. 2A , to present a larger interface surface. The spanning member  220  has ends  225   a,    225   p  that terminate in broad surfaces covering a larger area of the membrane  106 ; that is, the surface area of the head member  225   a  where it joins the inner surface of the anterior membrane portion  106   a  (by adhesion or co-molding) is sufficiently large relative to the surface area of the membrane portion  106   a  that, in concert with the surrounding anatomy, the head-member surface precludes or discourages the formation of bulges in the lens membrane  106  resulting from overfilling the lens  200 . The width (diameter) of each end  225  is typically no greater than 12 mm, and in some embodiments 5 mm or less. In other embodiments, the surfaces of one or both of the ends  225   a,    225   p  span the entire interior lens surface  106   a,    106   p,  thereby distributing the strain, caused by overfilling over this entire region. It should be understood, however, that the surfaces of one or both of the ends  225   a,    225   p  need not be uniform or symmetric round), or identical, or even unitary. For example, the profile of the end  225   a  may be optimized experimentally and/or with modeling to deform and minimize unwanted aberration as the lens  200  decreases in optical power during accommodation; as an example, the profile may vary radially in thickness. In other examples, the curvature provides a toric lens profile. But the end  225   p  may be broad for stress relief or small so as not to interfere with vision. That is, the profile of the end  225   a  may be dictated by optical considerations and that of the end  225   p  by mechanical or manufacturing considerations. 
         [0086]    A non-unitary end is illustrated in  FIG. 3 . Here the spanning member  320  forks into three branches  322   1 ,  322   2 ,  322   3  that terminate in ends  325   a   1 ,  325   a   2 ,  325   a   3 , respectively. Each of the ends  325   a  may have the same or a different contact area with the interior lens surface  106   a . It is the number and distribution pattern of the branches  322  and ends  325 , however, that determine the mechanical response of the lens to overfilling and/or accommodation-related stresses. By adjusting the placement of the branches  322  (which may also be present on the posterior side of the spanning member  320 ), the anterior and posterior membranes  106   a,    106   p  may be customized to better shape the lens  300  to an individual&#39;s natural anatomy in addition to fixing the maximum expansion of the lens  300 . Multiple branches  322  also distribute the strain on the membrane  106 . Multiple branches  322  may be arranged in a line or a small grouping in order, for example, to cause a bulge in the membrane  106  to occur outside the optical field and create an optical anomaly (e.g., different refraction, color change, shading, etc.) that signals an undesirable fill volume. 
         [0087]    Uniform and non-uniform end interfaces or attachment surfaces are illustrated in  FIGS. 4A through 5B .  FIGS. 5A and 5B  illustrate spanning members  420 ,  520  that appear, in sectional plan view, similar to the spanning member  220  shown in  FIG. 2A . The head-on elevational views of  FIGS. 4A and 4B , however, which run along the optical axes of the lenses  400 ,  500 , show different profiles of the attachment surfaces  428   a,    528   a  of the spanning members  420 ,  520 . The symmetric attachment surface  428   a  is round. The asymmetric attachment surface  528   a  has a series of finger-like projections emanating from a central point and having a desired angular offset  530  (approximately 40° in the illustrated embodiment). 
         [0088]    As shown in  FIG. 6 , the membrane portion overlying the round attachment surface  428   a  may have grooves or areas of reduced thickness  632  that run radially from a central point or along a custom path. These discontinuities may start in the optical center of the lens  600 , or may begin at a discrete radius from the optical center of the lens. They permit the resulting wedge segments to expand as pressure inside the lens increases, due to, for example, accommodation or overfilling. 
         [0089]      FIGS. 7A-7D  depict an IOL  700  as it transitions between near and far vision. IOL  700  comprises or consists of a rigid component  702  and a liquid-fillable lens  701 . Rigid component  702  and fluid-filled lens  701  may or may not be mechanically coupled. Light  720  passes through rigid component  702  without significant deviation or modification, as rigid component  702  has minimal optical properties and is substantially transparent. Light then passes through lens  701  and is focused at near point  722 . This corresponds to an accommodated lens and 100% of the light is focused at near focal point. 
         [0090]      FIG. 7B  depicts a substantially planar rigid component  702  as it comes into contact with fluid-filled lens  701 . Contact area  710  corresponds to the area where rigid component  702  deforms fluid-filled lens  701 , causing the contacting area of the anterior surface to have a different curvature and therefore a different refractive power. The light  724  that is refracted through the rigid component  702  and the deformed portions of fluid-filled lens  701  focuses at point  726 , which has a longer focal length than light contacting the peripheral non-deformed portions of the fluid-filled lens. The peripheral portions of fluid-filled lens  701  continue to focus at near point  722 . In this intermediate condition, the lens is acting as a multifocal lens, with portions focusing near and other portions focusing far. 
         [0091]      FIG. 7C  depicts further surface contact between rigid component  702  and fluid-filled lens  701 . Contact area  710  continues to expand radially, until it encompasses the entire optical portion of fluid-filled lens  701 .  FIG. 7D  depicts full contact between rigid member  702  and fluid-filled lens  701 . In this configuration, 100% of the focused light is focused at far point  726  and there is no multifocality of the lens. 
         [0092]    In this manner, this type of lens can act as a variable multifocal lens. In the two extremes (near and for viewing), the lens is a monofocal IOL, with 100% of the light projected for near or far viewing respectively. Intermediate viewing is associated with varying amount multifocality which gradually transitions in percentage from near viewing to far viewing. 
         [0093]      FIGS. 8A and 8B  depict fluid-filled lens  801  within a patients capsular bag  803 . In  FIG. 8A , the rigid component  802  is not in contact with the fluid-filled lens  801 . In other embodiments, the rigid component may have a skirt or ring-like structure that can slide around the outside of the fluid-filled lens  801 . The rigid component  802  may then have corresponding pins or holes in it that guide it vertically up and down during actuation, maintaining alignment between the rigid component and fluid-filled lens  801 . The rigid component  602  can be in contact with the capsular bag  803  in some embodiments. In some embodiments this contact is light and does not significantly affect the capsular bag  803 , while in other embodiments the rigid component  802  may be pushed anteriorly by the legs  804 , causing the capsular bag  803  to expand further vertically and collapse radially. The legs  804  push off the edge of the capsular bag equator  805 , where the zonules  806  connect and force the rigid component  802  anteriorly relative to the optical axis. 
         [0094]      FIG. 8B  depicts the zonules  806  applying a radial force (indicated by the arrow) to the equator  805  of the capsular bag. This tension expands the capsular bag radially and collapses it vertically. The capsular bag  803  in one embodiment compresses to the fluid-filled lens  801  and rigid component  802 . Anterior force on the fluid-filled lens  801  causes the posterior membrane of the fluid-filled lens  801  to flatten, which aids in accommodation. Outward expansion of the equator of the capsular bag  805  allows the legs  804  to also extend radially. As the legs  804  extend radially, the rigid component  802  is pushed posteriorly onto the fluid-filled lens  801 . This motion is also aided by the compressive force applied by the capsular bag  803  to the anterior surface of rigid component  802 . The rigid component  802  is then urged against the fluid-filled lens membrane, causing the lens membrane to change shape. In one embodiment, the rigid component  802  is stiff enough that it deforms the lens membrane to the shape of the rigid component  802 . In other embodiments the rigid component  802  has points that protrude out toward the fluid-filled lens  801 . These protrusions make contact with critical fulcrum points on the fluid-filled, lens  801 . These fulcrum points deform the lens membrane. 
         [0095]    FIGS. and  9 B depict a fluid-filled lens  901 , a rigid component  902  and coupling members  904  that space the fluid-filled lens  901  from the rigid component  902 . Coupling members  902  nominally maintain the rigid component anterior to fluid-filled lens  901  and centered to the optical axis as shown in the top view. Coupling members  902  may be hinged as shown. 
         [0096]    When the zonules go into tension, as seen as the arrow in the bottom view, the capsular bag  903  expands radially and with a decrease in anterior-posterior (A-P) thickness as shown in the figure. The A-P thickness decrease of the capsular bag  903  causes the bag to compress the posterior membrane of the fluid-filled lens  901  and brings the rigid component  902  into contact with anterior surface of fluid-filled lens  901 . In some embodiments, the compressive force on the posterior side of the fluid-filled lens  901  causes the membrane to deform, causing the lens  901  to press on the posterior membrane and undergo an optical power change. 
         [0097]    In various embodiments, the rigid component  902  is stiff enough to cause the fluid-filled lens membrane to conform to its shape. In other embodiments, the rigid component  902  has points that protrude out toward the fluid-filled lens  901 . These protrusions make contact with critical fulcrum points on the fluid-filled lens  901  (not shown). These fulcrum points then deform the membrane of the fluid-filled lens. In another embodiment, the rigid component  902  has some flexibility to it so that as it contacts fluid-filled lens  901 , the final state is an intermediate state between the curvature of the fluid-filled lens and that of the rigid component  902 . In this embodiment, the lens acts both as a multifocal lens and an accommodating IOL. In addition, the contact edges between the fluid-filled lens  901  and the rigid component  902  may be less discontinuous, leading to smooth transition between far and near focal points. 
         [0098]    In another embodiment of the invention, coupling features  904  interact with the equatorial region of the capsular bag  905 . In this embodiment the coupling features  904  maintain contact between the fluid-filled lens  901  and the rigid component  902 . The equatorial region of the capsular bag pushes radially on the coupling, members and moves the rigid member away from fluid-filled lens  901 . 
         [0099]    In certain embodiments, a structure around the fluid-filled lens  901  connects to the fluid-filled lens  901  and the coupling members  904 . In other embodiments, the coupling members act as a spring and may be assisted by the expansion and contraction of the capsular bag equator  905 . The coupling members may interact with the lens through a series of legs that extend to the lens periphery. In addition, these extensions that extend from the equator to the coupling member may be used to increase leverage or displacement and aid in the movement of the rigid component. 
         [0100]    The rigid component may itself have a non-spherical shape, with the possibility for correction or induction of aberration into the lens. In certain configurations it has multifocality itself, thereby convening the lens into a lens with a multifocal surface when engaged. The rigid component itself may also be to lens (monofocal, toric, multifocal, aspheric, and other configurations known to those skilled in the art). 
         [0101]    In other configurations, the rigid component deforms itself when engaging with the lens. Instead of two focal lengths, there is a smooth continuous change in curvature of the lens during engagement. In this manner, it may act as a smooth transition between near and far focus, with no multifocality. In this manner, the lens may be considered to have accommodation as well as a shift in multifocality. If the rigid component is flexible enough, the lens may act entirely or almost entirely as an accommodating intraocular lens, with a smooth monofocal transition between near and far viewing distance. 
         [0102]    In some embodiments the rigid component may have features that help integrate itself into the capsular bag. In some embodiments small holes could be cut into the capsular bag where small protrusions from the rigid component would stick through. As the capsular bag fibrosis, it will integrate with the protrusions on the rigid component. Other embodiments include but are not limited to: hooks, clasps (around the capsulorhexis), or snap in features (such as a male and female piece with the capsular bag locked inbetween). 
         [0103]    B. External Components 
         [0104]    Embodiments of the present invention feature fluid-filled (e.g., liquid-filled) accommodating IOLs having one or more haptics for force translation from and retention within the eye capsular bag. In various embodiments, the haptics are attached to the fluid-fillable lens of the IOL during manufacture thereof. In various embodiments, the stiffness (and/or other mechanical properties) of the haptics are selected to enable effective force transmission between the fluid-filled lens and the capsular bag. For example, greater flexibility may result in less force transmission to the lens while less flexibility may result in greater force transmission to the lens. Haptics in accordance with embodiments of the invention may include, consist essentially of, or consist of elongated filaments or fibers having any of a variety of different shapes. The material of the haptic may be different from that of the lens bag of the IOL and attached thereto during the manufacturing process. 
         [0105]    In various embodiments, the lens haptics include, consist essentially of, or consist of one or more biocompatible materials such as acrylic, polypropylene, polyvinylidene fluoride (e.g., KYNAR.), polyethersulfone, silicone, polyester, parylene, and/or a shape-memory alloy (e.g., an alloy of nickel and titanium such as nitinol). In various embodiments, the lens haptics may be composed of one or more non-biocompatible materials that are coated with one or more biocompatible materials. In various embodiments, the haptic includes, consists essentially of, or consists of a solid fiber or hollow tube of one or more materials that may be encapsulated by a coating of one or more different materials, e.g., to select a desired stiffness of the haptic. The thickness and/or composition of such coatings may be varied in different portions and/or along the length of the haptic in order to locally vary the flexibility of one or more portions of the haptic. 
         [0106]    In various embodiments, IOLs each have only two haptics for force transmission from the capsular bag to the lens. For example, the two haptics may be oriented directly across from each other along a diameter (e.g., the equatorial diameter that is perpendicular to the optical axis) of the lens.  FIG. 10A  depicts a fluid-filled IOL  1000  that includes or consists essentially of a hollow flexible lens  1010  and two haptics  1020  for force transmission from the eye capsular bag to the lens  1010 . In various embodiments, each haptic  1020  includes, consists essentially of, or consists of an acrylic fiber having a half-circle shape and that is attached to the lens  1010  with, e.g., a silicone adhesive and projects therefrom like a hook. IOL  1000  is depicted in a relaxed state in  FIG. 10A , in  FIG. 10B , the IOL  1000  is depicted in an accommodating state in which a compressive force F is applied to the haptics  1020 , deforming the lens  1010 . As shown, the shape of the lens  1010  is altered by the force F compared to its original, relaxed state (depicted as a dashed outline). 
         [0107]    Haptics in accordance with embodiments of the invention may have any of a variety of shapes different from the half-circular shape shown in  FIGS. 10A and 10B .  FIG. 10C  depicts an IOL  1000  having two circular haptics  1020 . For a given haptic material and fiber diameter, the full-circular shape of the haptics  1020  in  FIG. 10C  will generally be more rigid than the half-circular haptics shown in  FIG. 10A and 10B  and therefore may more efficiently translate compressive force from the eye capsular bag to the lens  1010 . In some embodiments, the haptics may be three-dimensional (e.g., spherical) rather than two-dimensional.  FIG. 10D  illustrates an IOL  1000  having two S-shaped haptics  1020 , which may be more flexible than half-circular haptics in various embodiments of the invention and exhibit greater mechanical interaction with the surrounding ocular anatomy. Other shapes for haptics  1020  may be selected by one of skill in the art and are within the scope of the present invention. 
         [0108]    In various embodiments, IOLs may each have three, four, five, or more haptics for force transmission; such embodiments may enable the transmitted flame to be more uniformly distributed around the periphery of the lens. For example,  FIG. 11A  depicts a fluid-filled IOL  1100  having four half-circular haptics  1020  attached to and spaced approximately equally around the lens  1010 .  FIG. 11B  depicts an IOL  1100  having four circular haptics  1020 , and  FIG. 11C  depicts an IOL  1100  having four S-shaped haptics  1020 . Such embodiments may improve the optical quality of lens  1010  via more uniform distribution of the force from the capsular bag. 
         [0109]    As mentioned above, the balloon-like lenses of IOLs in accordance with embodiments of the invention are flexible and therefore more vulnerable to degradation of optical quality from, e.g., wrinkling of the lens surface, asymmetric bulging of the optical zone of the lens, etc. Thus, embodiments of the present invention advantageously prevent deformation of the fluid-filled lens of the IOL resulting from direct interaction between the lens and the capsular bag and constrain deformation of the lens to result only (or substantially only) via the haptics attached to the lens. For example,  FIG. 12A  depicts a fluid-filled IOL  1200  having a solid protective ring or band  1210  disposed around the flexible lens  1010  along a direction that does not pass through the optical axis of the lens; in the figure, the optical axis passes through the center of the ring  1210 . As shown, the ring  1210  defines an opening or aperture therethrough for each of the haptics  120  to extend from the lens  1010  to the capsular bag. In this manner, force from the capsular bag is transmitted to the lens  1010  only via the haptics  1020 , rather than via any direct interaction between the lens  1010  and the capsular bag. Moreover, the openings in the ring  1210  may also help to constrain motion and/or deformation of the haptics  1020  themselves that might result from compressive force from the capsular bag.  FIG. 12B  depicts the IOL  1200  in an accommodative state (as contrasted with the relaxed state depicted in  FIG. 12A ), showing deformation of the lens  1010  resulting from force F transmitted via the haptics  1020  through the ring  1210 , IOL  1200  may feature haptics having different shapes— FIG. 12C  depicts an IOL  1200  having circular haptics. In addition, IOL  1200  may feature more than two haptics  1020 . For example,  FIG. 12D  depicts an IOL  1200  having four half-circular haptics  1020  each extending through ring  1210  and once again, not passing through the optical axis of the lens. In general, the haptics are arranged symmetrically around the IOL  1200 . In some embodiments, however, the haptics are arranged in a manner responsive to the forces of accommodation, e.g., they may be concentrated where the zonules apply maximum force to the IOL. 
         [0110]    The ring  1210  may include, consist essentially of, or consist of one or more biocompatible materials such as high-durometer silicone, parylene, acrylic, or collagen or a collagen derivative. As described above regarding haptic  1020 , the ring  1210  may be composed of a non-biocompatible material coated with one or more biocompatible materials. According to the material selection of the ring, haptic, and lens, the components may be bonded using an adhesive, overmolded in portions, molded as anterior and posterior pieces, or molded in a unitary piece. In various embodiments featuring ring  1210 , one or more of the haptics  1020  may include stops that limit the penetration depth of the haptic  1020  into the interior of ring  1210 . In various embodiments, the ring  1210  includes, consists essentially of, or consists of silicone having a cross section of approximately 1 mm×2 mm the ring  1210  is therefore much less flexible than the lens  1010 , which may have a thickness of, liar example approximately 20 μm to approximately 100 μm. 
         [0111]    In various embodiments of the present invention, the local elastic properties of the flexible lens of the IOL are altered via incorporation of a reinforcement pattern disposed on the lens surface or within the lens (e.g., at or near the lens equator), ideally outside the optical zone of the lens. Advantageously, the force transmission by the haptics to the lens may be focused at particular portions of the reinforcement pattern and transmitted to the lens through the reinforcement pattern, thereby minimizing or substantially eliminating undesired wrinkling or bulging of other portions of the lens. For example, the reinforcement pattern may have a polygonal shape (e.g., triangle, square, pentagon, hexagon, etc.), with each haptic of the IOL attached to the lens at a point corresponding to one of the vertices of the polygon. For example,  FIG. 13A  depicts, in a relaxed state, as fluid-filled IOL  1300  having four haptics  1020  that are affixed to lens  1010  at locations corresponding to vertices of a square-shaped reinforcement pattern  1310 . The reinforcement pattern is more rigid (i.e., less flexible) than the membrane of lens  1010  and acts as a skeleton or frame to sustain the shape change of lens  1010 .  FIG. 13B  depicts IOL  1300  in an accommodating state, in which compressive force is applied by the capsular bag and transmitted to the reinforcement pattern  1310  via the haptics  1020 . As shown, the reinforcement pattern  1310  curves, deforms, and/or stretches into a more circular pattern, thereby altering the shape of the lens  1010  to the shape corresponding to the desired optical power (the original shape of reinforcement pattern  1310  is shown in dashed lines).  FIG. 13C and 13D  depict IOLs  1300  having a pentagonal reinforcement patter  1310  and a hexagonal reinforcement pattern, respectively. Such higher-order polygons may, in various embodiments, distribute the force transmitted by the haptics more uniformly to the surface of lens  1010 . Polygonal reinforcement patterns  1310  having more than six vertices are within the scope of the present invention. Although  FIGS. 13A-13D  depict a haptic  1020  connecting to the lens  1010  at every vertex of reinforcement pattern  1310 , this is not a requirement, and in various embodiments of the invention one or more vertices of reinforcement pattern  1310  are disposed at points on lens  1010  where haptics  1020  do not connect thereto. 
         [0112]    As mentioned above, in various embodiments of the invention the reinforcement pattern  1310  is less flexible than the membrane of the lens  1010 . For example, the reinforcement pattern  1310  may include, consist essentially of, or consist of a less flexible material than the membrane, and/or may have a lamer thickness than that of the membrane. The reinforcement pattern  1310  may include, consist essentially of, or consist of, for example, a biocompatible material such as silicone, a silicone derivative such as a fluorosilicone, phenyl-silicone, or parylene. The reinforcement pattern  1310  may be fabricated on the lens  1010  membrane via, for example, local deposition (e.g., vapor deposition), molding, or a coating process such as spray- or dip-coating. In various embodiments, the reinforcement pattern  1310  is composed of a coating that is a dispersant with a volatile component and a non-volatile component. In such embodiments, the dispersant has a low viscosity to allow coating and/or shaping until the volatile component is evaporated from the base material (e.g., a polymer). 
         [0113]    The haptics of the IOL need not be elongated fibers, the ends of which are affixed to the lens at a point. Rather, in accordance with embodiments of the present invention, haptics may include, consist essentially of, or consist of partial curved rings that each surrounds a portion of the periphery of the lens. In such embodiments, the IOL may feature two or more haptics that collectively contact and surround only a portion of the periphery of the lens—gaps between the partial-ring haptics allow the lens to change shape in response to the force transmitted to the lens by the haptics. The partial-ring haptics may be substantially rigid rather than flexible and thus not deform while transmitting force from the capsular bag to the lens of the IOL. (In other embodiments, the partial-ring haptics may be flexible but preferably less flexible than the membrane of the lens.) As an example,  FIG. 14A  depicts a fluid-filled IOL  1400  featuring two partial-ring haptics  1410 . As shown, the haptics  1410  partially surround, while defining gaps along, the periphery of lens  1010 .  FIG. 14B  depicts the IOL  1400  in an accommodative state under a force F from the capsular bag. As shown, the lens  1010  is deformed from its original shape (shown as a dashed line) as the haptics  1410  compress the lens  1010  toward each other, at least partially closing the gaps between the haptics. In various embodiments, the gap distance between the haptics corresponds to the maximum amount of deformation of the lens  1010  that the lens can tolerate (for example, before rupture or irreversible shape change) and/or to a maximum amount of optical power change desired in the patient&#39;s eye; once the gaps between the haptics  1410  close and the haptics  1410  come into contact, the haptics  1410  may be sufficiently rigid such that no additional deformation of the lens  1010  occurs. In various embodiments of the invention, an IOL  1400  may feature more than two partial-ring haptics  1410 , as shown in  FIG. 14C  (four partial-ring haptics  1410 ) and  FIG. 14D  (six partial-ring haptics  1410 ). In various embodiments, the greater the number of partial-ring haptics  1410  utilized to transmit three from the capsular bag, the more uniform is the resulting deformation of the surface of the lens  1010 . 
         [0114]    Partial-ring haptics  1410  may include, consist essentially of, or consist of one or more biocompatible materials such as acrylic, polypropylene, polyvinylidene fluoride (e.g., KYNAR), polyethersulfone, silicone, polyester, parylene, shape-memory alloy (e.g., an alloy of nickel and titanium such as nitinol). In various embodiments, the haptics  1410  may be composed of one or more non-biocompatible materials that are coated with one or more biocompatible materials. The haptics  1410  may be pre-manufactured and attached to the lens  1010  via, e.g., an adhesive (e.g., silicone adhesive), or the haptics  1410  may be molded together with the lens  1010  during fabrication thereof. In various embodiments, the haptics  1410  may be deposited (e.g., vapor deposited) on the lens  1010  or spray- or dip-coated onto the lens  1010 . 
         [0115]    In various embodiments of the present invention, the haptics do not transmit force directly from the capsular bag to the lens of the IOL. Instead, a flexible, elastic ring may surround the periphery of the lens and be connected to the lens is two or more haptics. (As used herein, the term “ring” is used to connote a closed shape that is not necessarily circular; rather, a ring. may be, e.g., elliptical, polygonal, or irregular in shape.) In such embodiments, the force from the capsular bag first distorts the flexible ring, which in turn deforms and/or translates the haptics, resulting in deformation of the shape of the lens. In some embodiments, the haptics may extend partially or completely through apertures defined by the flexible ring, similar to the configuration described above for IOL  1200  (and, in such embodiments, the haptics and/or the ring may incorporate stops to retard or prevent further motion of the haptics after a pre-determined amount of force is transmitted thereby).  FIG. 15A  depicts an exemplary fluid-filled IOL  1500 , in accordance with embodiments of the invention, which includes an elastic ring  1510  surrounding and in contact with multiple haptics  1020 , which in turn are affixed to the lens  1010 . As shown, the haptics may be have a V shape (or may be individual linear haptics assembled into multiple V shapes). While  FIG. 15A  depicts IOL  1500  in a relaxed state, FIG,  5 B shows IOL  1500  in an accommodated state in which a force F has compressed the ring  1510 , in turn compressing the haptics  1020 , which alter the shape of the lens  1010 . While  FIG. 15A and 15B  show IOL  1500  having four haptics  1020 , embodiments of the invention may have fewer or more than four haptics  1020  surrounded by ring  1510 . For example,  FIG. 15C  depicts IOL  1500  as having eight haptics  1020 . 
         [0116]    The ring  1510  may include, consist essentially of, or consist of one or more biocompatible materials such as acrylic, polypropylene, polyvinylidene fluoride (e.g., KYNAR), polyethersulfone, silicone, polyester, parylene, shape-memory alloy (e.g., an alloy of nickel and titanium such as nitinol). In various embodiments, the ring  1510  may be composed of one or more non-biocompatible materials that are coated with one or more biocompatible materials. The ring  1510  may be pre-manufactured and attached to the haptics  1020  via, e.g., an adhesive (e.g., silicone adhesive), or the ring  610  may be molded together with the haptics  1020  and/or the lens  1010  during fabrication thereof. 
         [0117]    IOLs in accordance with embodiments of the invention may be implanted with minimal or no volume of fluid within the lens to decrease IOL size and this the incision size required to implant the IOL within a patient&#39;s eye. The lens may contain one or more valves accessible from an external portion of the lens with a needle or other fluid line for filling. Such valves may be self-sealing, e.g., as described in U.S. patent application Ser. No. 14/980,116, filed on Dec. 28, 2015, the entire disclosure of which is incorporated by reference herein. 
         [0118]    C. Multiple-Component IOL 
         [0119]    Refer to  FIGS. 16A and 16B , which depict a multiple-component IOL with a central liquid-filled lens  1602  and a solid haptic peripheral component surrounding the lens  1602 .  FIG. 16B  provides an exploded view, while  FIG. 16B  illustrates the implantable configuration. The peripheral component comprises or consists of a retaining structure  1606 , which may feature two or more projecting haptics  1604 . When haptics are used, they are typically attached to retaining structure  1606 , which provides the mechanical interface between the haptics  1604  and the liquid-filled lens  1602 . Fluid-filled lens  1602  has a valve  1612 , which is used to fill the lens  1602 . In an embodiment, the retaining portion  1606  is implanted first. Then the fluid-filled lens  1602  is implanted in an empty state, and subsequently filled through valve  1612 . During filling, an interface feature  1610  of the fluid-filled lens  1602  comes into contact with the inner surface of the retaining portion  1606  or, in some cases, an end of a haptic  1604 . This latter mechanical coupling option allows the haptics  1604  to directly apply force to or retain fluid-filled lens  1602 . There may be one interface feature  1612  for each haptic  1604  of the lens assembly. 
         [0120]    Haptics  1604  may be free to move radially within the retaining structure  1606 , but may have stops that limit total travel in one or more directions. This prevents the haptics from becoming disengaged from the retaining structure  1606  during implantation, from being too far internally to interact with fluid-filled lens  1602 , or interfering with fluid-filled lens implantation into the retaining structure. In a similar manner, haptics  1604  may be constrained by the retaining structure  1606  so they do not rotate. 
         [0121]    In other embodiments of the invention, haptics  1604  are mechanically constrained and fixed in retaining structure  1606  and provide no mechanical coupling to fluid-filled lens  1602 . In such cases, fluid-filled lens  1602  interfaces with the retaining structure  1606  in order to maintain its position relative to the lens capsule. If haptics  1604  are omitted, retaining structure  1606  makes contact with the lens capsule on one or more suffices (e.g., anterior, posterior, peripheral) thereof. 
         [0122]      FIGS. 17A-17D  illustrate a multiple-component IOL comprising or consisting of a central fluid-filled lens  1702  and a fluid-filled haptic component  1708 .  FIG. 17A  shows the lens  1702  and haptic  1708  in an exploded view and  FIGS. 17B and 17C  are cutaway isometric and elevational views, respectively. Fluid-filled lens component  1702  has a valve  1712  for filling, interface features  1710  that mate with fluid-filled haptic component  1708  via mating interface features  1722 . In this configuration the haptic component  1708  may be implanted first, either filled or unfilled. Next, the fluid-filled lens component  1702  is implanted. During implantation, interface features  1710  mate with interface features  1722  in fluid-filled haptic  1708 . As the lens  1702  is filled, the features  1710 ,  1722  come into mechanical contact and couple. During this process, fluidic continuity between haptic component  1708  and fluid-filled lens component  1702  may be established, and the fluid-filled haptic  1708  is subsequently filled. 
         [0123]    In other embodiments, fluid-filled haptic component  1708  is separately filled after implantation, or pre-filled during implantation. In such circumstances, the features  1710 ,  1722  mechanically restrain and couple the fluid-filled lens component  1702  to the fluid-filled haptic component  1708 . 
         [0124]    Although shown as discrete elements, interface features  1702 ,  1722  may be as simple as a radial mechanical interface (e.g., a raised off-round tab and a complementary recess) between fluid-filled lens component  1702  and fluid-filled haptic component  1708  during filling, or may instead be a roughened surface or simple stiction between the two components. This mechanical interface may be enhanced through the use of surface modification (e.g., oxygen and/or nitrogen plasma treatment, parylene deposition into the surface, or adding other functional groups), surface roughness (e.g., etching the surface), or using localized hydrogen bonding, ionic bonding, or hydrophobic bonding between the surfaces. In other embodiments, surface linking is increased by using polymers that continue to cure after implantation. This includes silicone elastomers that have been partially cured, but continue to cure post-implantation. 
         [0125]      FIG. 17D  shows how, after implantation, the fluid-filled haptic component  208  may wrap at least partially circumferentially around the equator of the capsular bag  1750 . The lens component  1702  is attached to the fluid-filled haptic by interface features  1710  or portions thereof. The fluid-filled haptic component  1708  centers both radial and tilt characteristics of the attached lens component  1702  (as shown in the dashed lines) inside the capsular bag  1750 . These self-centering and self-alignment characteristics of the haptic component  1708  may be adjusted by modifying the capsule interfacing contours of the haptic component. The fluid-filled haptic component  1708  is located near the anatomical region where the zonules  1755  connect with the capsular bag  1750 . The zonules  1755  relax and tighten to change the tension and shape of the capsular bag  1750 . As the zonules tighten, the capsular bag  1750  extends radially (i.e., horizontally in  FIG. 17D ), but also collapses axially (i.e., vertically in  FIG. 17D ). The positioning of one or more fluid-filled haptic components near the equator of the capsular bag  1750  allows it to transmit the forces and pressure from the zonules efficiently. In some embodiments, the forces may be optionally transmitted via physical contact or fluid interaction between the fluid-filled lens component  1702  and the fluid-filled haptic component  1708 . 
         [0126]      FIGS. 18A-18C  depict an exemplary a coupling mechanism to provide fluidic continuity between two components of the IOL after implantation.  FIG. 18A  shows the components before engagement,  FIG. 18B  shows partial engagement, and  FIG. 18C  depicts full engagement of the two components and consequent fluidic continuity between the two components. 
         [0127]    One component comprises or consists of a wall  1838  and a valve  1834 . The first component has an internal fluid compartment to the left of wall  1838 . The second component comprises or consists of a wall  1836  and valve  1832 . The internal fluid compartment of the second component is to the right of wall  1836 . In  FIG. 18A , a penetrating member  1830  is partially engaged in valve  1834  and not engaged in second component valve  1832 . As the two components are brought together, penetrating member  1830  engages valve  1832 , and then penetrates both valves  1834  and  1832  to allow fluidic contact  1840  between the two components. 
         [0128]      FIGS. 19A-19C  depict another exemplary coupling mechanism to provide fluidic continuity between two components of the IOL after implantation. Here the first component has a sharp penetrating member  1930 , which is integrated with (e.g., co-molded with or permanently attached to) the wall  1938 . The internal fluid compartment of the second component is to the right of wall  1936 . Contact between the two components causes sharp penetrating member  1930  to penetrate coupling portion  1932  of the second component. This may occur during inflation of either the first or second component. 
         [0129]    For example, a haptic component may comprise a haptic wall  1938  and a coupling portion  1934  with a protruding sharp penetrating member  1930 . The sharp penetrating member  1930  is already in fluidic contact with the haptic component. When fluid-filled lens component is filled, a lens coupling member  1932  comes into contact with sharp penetrating membrane  1930 . As inflation continues, sharp penetrating member  1930  penetrates fluid-filled lens coupling member  1932 , leading to fluidic continuity between the haptic and the lens. The haptic component can then be filled along with the fluid-filled lens component. 
         [0130]    Other coupling mechanisms are possible. One example uses two-piece valves that couple together and open after interlocking. A second example uses pressure between the lens component and haptic component to seal. A third example uses glue or adhesive that holds the two components together. In certain embodiments, the two pieces come into contact. Then at a later time an aperture is opened between the two membranes using an optical or thermal source, e.g., a Nd:YAG laser, femtosecond laser, picosecond laser, or other thermal or optical source. 
         [0131]      FIGS. 20A and 20B  depict an intraocular lens component  2002  with a surrounding haptic component  2006 . Haptic component  2006  has a valve  2012 , which is used to fill the haptic component. Haptic component  2006  is used to seat intraocular lens component  2002  properly in the lens capsule. It may be implanted, before, during, or after intraocular lens component  2006  has been implanted. 
         [0132]    Haptic component  2006  controls the environment around intraocular lens  2014 . The environment may determine, for example, specific optical properties, chronic dopants, and pressure that collectively create a net optical outcome in conjunction with the optical properties of the lens component  2002 . In addition, haptic component  2006  can be used to adjust the position of the intraocular lens component  2002 . 
         [0133]    Haptic component can be inflated to space the surrounding lens capsule away from intraocular lens component  2002 . In certain embodiments, haptic component  2006  is inserted and inflated, stabilizing the lens capsule. After implantation of haptic component  2006 , the lens capsule is modified for better postoperative outcomes. This modification may involve elimination of residual cells and/or lens matrix, or removal of portions of the lens capsule. Cytotoxic agents or agents to prevent chemotaxis of residual lens epithelial cells may be used to prevent cell migration and subsequent capsular opacification and/or fibrosis. Cytotoxic agents include fluids such as hypotoric aqueous solution (e.g., saline, water, dextrose, or mannitol) or cytotoxic solution (e.g., local chemotherapeutics such as methotrexate, etc.). Alternatively or in addition, surface modification (oxygen plasma, ammonia plasma, nitrogen plasma, parylene deposition, etc.) may be used to eliminate remnant cells in the lens capsule. These agents may be applied to the capsule as a lavage, or impregnated into the surface or filling fluid of the lens and/or haptic. Other types of modification include removing portions of the lens capsule while the lens capsule is supported by this surrounding/haptic component of the IOL. For example, after implantation of the haptic member, the posterior lens capsule may be mechanically removed, treated with laser (Nd:YAG, femtosecond laser, etc.), or thermally ablated. After treatment, intraocular lens component  2002  can be implanted into the lens capsule. 
         [0134]    The intraocular lens may be positioned within the capsular bag by altering the fluid fill of the haptic component  2006 . For example, if intraocular lens component  2002  is mechanically coupled to haptic component  2006 , then by increasing the fill in different portions or compartments (not shown) of haptic component  2006 , the lens can be repositioned, re-centered, tip/tilted, moved anteriorly or posteriorly. In addition, the lens can be rotated. Therefore, an intraocular lens component  2002  that is already mounted can be optimized either during or post-implantation for better refractive outcomes. 
         [0135]      FIGS. 21A and 21B  depict a multiple-component haptic member  2106  with one or more filling valves  2112  and an intraocular lens component  2102 . This configuration may be used in the same manner as described above with reference to  FIGS. 20A and 20B . However, here multiple chambers are depicted, making it more evident how tip/tilting or positioning of the lens occurs with preferential filling of one of the two haptics. In a similar manner, there may be more than two haptic components  2106  (e.g., haptic member  2114 ), there may be struts mechanically constraining the haptic members  2106 , or one or more haptic members may be continuous with multiple filling chambers to allow differential movement of intraocular lens  2102 . 
         [0136]      FIGS. 22A-22C  depict the use of a “piggyback” lens component  2254 . ( FIG. 22C  is a sectional view taken along the line A-A of  FIG. 22B .) This piggyback lens component  2254  is most frequently used to correct refractive error or aberration from intraocular lens component  2202  after implantation. As an example, if intraocular lens component  2202  is implanted with an incorrect refractive power, the surgeon may place the piggyback lens to correct overall aberration. In certain circumstances this is less traumatic to the eye than intraocular lens exchange. In addition, piggyback lens component  2254  may have a valve  2212  to allow for adjusting the fit between the piggyback lens component  2254  and the IOL component  2202  as well as refraction of piggyback lens component  2254 . Retention features  2252  may be used to directly couple and center piggyback lens component  2254  to IOL component  2202 . Optionally, the retention features  2252  may be configured to retain the intraocular lens component  2202  through the fill adjustment process of the valve  2212 . 
         [0137]    The fluid-filled portions of the multiple-component implantable IOL are constructed of a biocompatible materials such as a polymer (e.g., parylene, silicone, silicone derivative such as a phenyl-substituted silicone, acrylic, polysulfone, hydrogel, collagen, or other suitable material). In certain embodiments, the membrane portions comprise or consist essentially of multiple materials (e.g., layered fluorosilicone and silicone, parylene deposited into or onto silicone, etc.). When a portion of the fluid-filled component acts as a lens, a biocompatible refractive filling fluid may be used. Examples of these fluids include but are not limited to oils such as silicone oil, fluorosilicone, phenyl-substituted silicone oil, perfluorocarbon, an aqueous material such as a sugar water, vegetable oil, gel, hydrogel, nanocomposite, or electrically active fluid. Other fluids include saline, ringers solution, or other aqueous solutions. In certain embodiments the chambers are filled with an osmotically active solute. By placing the component into the eye, the chamber fills through diffusion of aqueous fluid into the chamber. In other embodiments, the walls of the fluid-filled chambers are semipermeable to air and gas, allowing trapped air bubbles or gas to diffuse out over a period of time. 
         [0138]    Reference throughout this specification to “one example,” “an example,” “one embodiment,” or “an embodiment” means that a particular feature, structure, or characteristic described in connection with the example is included in at least one example of the present technology. Thus, the occurrences of the phrases “in one example,” “in an example,” “one embodiment,” or “an embodiment” in various places throughout this specification are not necessarily all referring to the same example. Furthermore, the particular features, structures, routines, steps, or characteristics may be combined in any suitable manner in one or more examples of the technology. The headings provided herein are for convenience only and are not intended to limit or interpret the scope or meaning of the claimed technology. 
         [0139]    The terms and expressions employed herein are used as terms and expressions of description and not of limitation, and there is no intention, in the use of such terms and expressions, of excluding any equivalents of the features shown and described or portions thereof. In addition, having described certain embodiments of the invention, it will be apparent to those of ordinary skill in the art that other embodiments incorporating the concepts disclosed herein may be used without departing from the spirit and scope of the invention. Accordingly, the described embodiments are to be considered in all respects as only illustrative and not restrictive.