Abstract:
Temporary intraocular lenses are provided for disposing in eyes after removal of natural lenses. According to the invention, retinoscopy is performed with one of successive lenses to determine appropriate optical power of a permanent lens which is then installed. Temporary economical lenses are foldable and adapted for such procedures.

Description:
RELATED APPLICATIONS  
       [0001]    This application is a continuation-in-part of my co-pending application Ser. No. 09/472,306, filed Dec. 27, 1999. 
     
    
     
       BACKGROUND AND SUMMARY OF THE INVENTION  
         [0002]    The present invention relates generally to ophthalmology, and particularly to the utilization of a temporary intraocular lens for determining the optical power requirement for a permanent intraocular lens to be implanted in a particular eye, whereafter the temporary lens is removed and a permanent lens of predetermined optical power is installed.  
           [0003]    The present invention provides substantial assurance that a permanent lens of correct optical power is implanted in a first surgical procedure. FIG. 5 shows a preferred form of intraocular lens  30  disposed in an eye and comprising an optic  32  and oppositely extending haptics  34 ,  36  engaged in a capsular bag rim.  
           [0004]    It is desired to avoid the necessity of removal of an implanted lens after installation thereof in an eye, then replace it with another lens of more accurate optical characteristics for a particular eye.  
           [0005]    With an unsuitable intraocular lens implanted with an unsatisfactory outcome for the patient, it may result in optical imbalance between the two eyes of a patient, substantial patient dissatisfaction, increased dependence upon optical lenses or contact lenses, and additional surgery. Such additional surgery involves substantial cost and time and effort of the surgeon, patient inconvenience, suffering and trauma, medical risks, and legal complications.  
           [0006]    A variety of causes may result in error in the final outcome of such surgery, utilizing established techniques. The length of the particular eye may not be accurately measured, or corneal curvature may not be accurately measured, or the corneal-retinal distance may not be accurately pre-operatively measured by ultrasound, etc.  
           [0007]    Accommodating lenses, these being adjustable focus lenses, require precision in power selection; replacement of such lenses is inherently more costly and more complex and likely to result in probably requiring further surgical intervention. The present invention may be utilized with various types of intraocular lenses, and relative to various intraocular lens procedures.  
           [0008]    The invention provides temporary evaluation lenses and methods of using the same, to enable the provision of an intraocular lens of correct power for insertion into an eye of a particular person. The temporary lens has an optical power estimated for an appropriate permanent lens. With the temporary lens disposed in the eye, retinoscopy is performed and the temporary lens is then removed, and a correct permanent intraocular lens is implanted, this lens having a power determined by the retinoscopy. A preferred evaluation lens is provided which is of simplified and economical structure.  
           [0009]    [0009]FIG. 4 illustrates the disposition of a temporary IOL in an eye in more than one position. As shown, it may be disposed in the anterior chamber of the eye on the anterior surface of the iris, or within the capsular bag remnant after the natural lens is extracted, or between the capsular bag and the posterior surface of the iris. Each such different location of the temporary IOL action results in a different optical power result for a given lens.  
           [0010]    It is desirable that a temporary lens be relatively easily inserted into an eye and removed therefrom, without substantial detailed procedure. A temporary lens is selected for having optical power generally approximating the estimated optical power needed in a permanent implanted lens.  
           [0011]    It may be appropriate or necessary to insert and remove successive temporary lenses determining the accurate optical power for the permanent intraocular lens. Often, a surgeon may interpose a succession of lens of different respective powers in order to neutralize motion during retinoscopy in order to determine the correct desired optical power of the permanent IOL. A temporary IOL may be smaller in size than a permanent IOL. An optic size of 4½ mm provides the needed reading to determine appropriate optical power. With the temporary lens, there is no concern regarding providing long-term optical power, but it is only necessary to provide accuracy of a central portion of a lens.  
           [0012]    A temporary lens may be considered to be somewhat in the nature of an instrument, and more of a guide than an implant. Thus, relative ease of insertion and removal are provided, and control is maintained over the IOL positions at all times during surgical procedures. When it has been inserted in an eye, the surgeon can still control it from outside the eye, and it is removed like an instrument. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0013]    [0013]FIG. 1 is an exploded view diagrammatically illustrating utilization of retinoscopy for determination of correct lens power, according to the invention;  
         [0014]    [0014]FIG. 2 is a perspective view of a temporary intraocular lens utilized in accordance with the invention;  
         [0015]    [0015]FIG. 3 shows a sectional view of an eye and an insertion instrument during insertion of the lens of FIG. 2;  
         [0016]    [0016]FIG. 4 shows respective positions wherein the temporary lens of FIG. 2 may be installed in an eye;  
         [0017]    [0017]FIG. 5 shows a preferred form of intraocular lens disposed in an eye, and having an optic with oppositely extending haptics engaging a capsular bag;  
         [0018]    [0018]FIGS. 6A and 6B show a temporary intraocular lens having three stems extending therefrom with openings to receive an instrument;  
         [0019]    [0019]FIGS. 7A and 7B show a temporary intraocular lens having four stems extending radially therefrom with openings to receive a hook of an instrument, as shown;  
         [0020]    [0020]FIGS. 8 and 9 are sectional views showing the temporary intraocular lens of FIGS. 7A and 7B with stems thereof disposed relative to the iris and capsular bag rim remnant;  
         [0021]    [0021]FIGS. 10A and 10B show a temporary intraocular lens having three tapered stems extending radially therefrom, and an elongated handle extending therefrom having five openings to receive an instrument;  
         [0022]    [0022]FIGS. 11A and 11B show a temporary intraocular lens having three spaced-apart stems extending radially therefrom extending upwardly and outwardly from an optic, and further showing a fenestration in the periphery of the optic to receive an instrument;  
         [0023]    [0023]FIGS. 12A and 12B show a temporary intraocular lens having three stems extending radially therefrom and a suture anchor extending from the optic to receive a suture wound thereabout;  
         [0024]    [0024]FIGS. 13A and 13B show a temporary intraocular lens having three tapered stems extending therefrom, and a suture anchor defined by notches in the periphery of the optic;  
         [0025]    [0025]FIGS. 14A and 14B show a temporary intraocular lens having three stems extending radially therefrom and having openings therein, one of the stems extending upwardly and outwardly from a periphery of the optic;  
         [0026]    [0026]FIGS. 15A and 15B show a temporary intraocular lens having three tapered stems extending radially therefrom, and an elongated handle extending upwardly and outwardly from the optic with openings therein; and  
         [0027]    [0027]FIGS. 16A and 16B show a temporary intraocular lens having three stems extending radially therefrom and an instrument retainer defined in a peripheral portion of the optic.  
     
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0028]    The present invention utilizes a foldable temporary intraocular lens which is inserted into an eye for evaluation by a surgeon of the refractive status of the eye relative to the optical power of the temporary lens. The temporary lens serves to evaluate the optical function of the eye to determine the appropriate and correct power for a permanent lens implant.  
         [0029]    Referring to the drawings, particularly FIGS. 1 and 2, a temporary lens  10  is shown as comprising a central optic  12 , and three haptics  14 , attached to and extending radially therefrom. This lens has an optic selected to approximate the estimated power of the permanent lens to be inserted. The temporary lens is flexible, foldable, and is implantable via a small incision in the eye, by known procedures, or by other methods. The temporary lens is inexpensive and disposable after use.  
         [0030]    The temporary lens  10  is utilized with the present invention to provide data, by retinoscopy, etc., to enable the provision of a permanent intraocular lens of correct power and accuracy into the eye of a person.  
         [0031]    The temporary lens  10  has three haptics  14  extending at 120° intervals about the optic  12 , the outer edges of the haptic falling in a circle of about 12.75 mm diameter.  
         [0032]    Perforations of about 0.5 mm diameter are disposed on the haptics  14  to better enable handling and manipulation by surgical instrumentation, and for removal from an eye by an instrument.  
         [0033]    Utilizing techniques known in the art, the temporary lens  10  may be positioned, as shown in FIG. 4, anteriorly of an iris, as indicated at  16 , posteriorly of the iris, indicated at  18 , or within the capsular bag, as indicated at  20 . As indicated in FIG. 3, insertion of lens  10  via a slit in the cornea  21  is by an insertion instrument  23 .  
         [0034]    Referring to FIG. 1, at the time of surgery, retinoscopy is utilized to determine the effectiveness of a selected lens optic, and to quantify any adjustment necessary in the power of the intraocular lens for final insertion. By retinoscopy, well known in the art, reflections from the retina  22  of the eye  27  are utilized involving a light source  24  and the eye  26  of the surgeon to determine the total optical power of an eye having a natural lens  29 . By interposing a succession of temporary lenses  28 , the surgeon can calculate any required additional lens power required for desired optical power in a particular case.  
         [0035]    Following retinoscopy, the temporary lens  10  is extracted from the eye by appropriate instrumentation and known techniques, the lens passing from the eye via a small incision.  
         [0036]    Utilizing information derived from retinoscopy and utilization of the temporary lens, the surgeon determines the power of a permanent intraocular lens  30  (FIG. 5) which is inserted by known techniques for desired optical results. The lens  30  comprises an optic  32  and haptics  34 ,  36  extending oppositely therefrom to engage opposite portions of a capsular bag  40  equator, with wing portions  38  thereof further engaging the bag equator.  
         [0037]    Referring to the drawings, various embodiments of temporary intraocular lenses according to the invention, are shown in FIGS.  6 - 16 .  
         [0038]    Each embodiment shown has at least one element which extends from an optic to enable a surgeon to manipulate the lens in the eye. The element may be a stem which does not extend outside the eye, with the lens within the eye. A handle is an element of such length that it has a portion extending outside the eye, with the optic inside the eye.  
         [0039]    One or more openings or holes may be provided in a stem or in a handle for engagement therein of a hook portion of an instrument for the manipulation of the IOL in the eye for insertion, removal, and manipulation of the lens.  
         [0040]    It is of course not desirable to provide holes or openings in a permanent IOL implant, because it is necessary to avoid light being disposed in any unplanned manner on any relatively permanent basis.  
         [0041]    [0041]FIGS. 6A and 6B show a temporary IOL  50  having three stems  52 ,  54 ,  56  extending radially from an optic, and a fenestration  58  in the periphery of the optic, all of which are adapted to receive a hook or like portion of an instrument for manipulation of the optic in the eye.  
         [0042]    [0042]FIGS. 7A, 7B show a temporary IOL  60  with four radially-spaced stems  61 ,  63 ,  64 ,  65  extending from an optic in radially-spaced relation, three of such stems having a single opening  62  therein, and one stem  64  having four spaced-apart openings  66  to receive a hook portion  67  of an instrument  68 , as shown. One stem  64  is relatively thick and rigid. The stem having four openings  66  therein has a portion extending upwardly or axially of the optic from a peripheral portion of the optic, and an elongated portion extending from said portion and generally perpendicular to a central axis of the optic.  
         [0043]    [0043]FIGS. 8 and 9 show a temporary lens  70  of FIGS. 7A, 7B disposed in an eye with its stem  72  (FIG. 8) disposed on the anterior surface of the iris, with the opposite stem  74  disposed in the sulcus between the iris and the anterior capsular bag rim. FIG. 9 shows the lens  70  disposed in the eye with its left stem disposed on the anterior surface of the iris, and its opposite stem  74  disposed within the capsular bag rim  76 .  
         [0044]    Thus, a temporary IOL may be disposed in various features within an eye and in stable position during surgical procedures.  
         [0045]    [0045]FIGS. 10A and 10B show a temporary lens  80  having three spaced-apart stems  82 ,  84 ,  86  extending outwardly from an optic and narrowing outwardly, each having an opening  87  to receive an instrument. An elongated handle  88  extends outside the eye and has five openings  89  therein for selective positioning of a hook of an instrument for manipulation of the lens within the eye.  
         [0046]    [0046]FIGS. 11A and 11B show a temporary lens  90  with three stems  92 ,  94 ,  96  extending generally radially from an optic, each stem having a portion  98  extending upwardly from a peripheral to portion of an optic, and a portion  100  extending generally radially outwardly therefrom for positioning on a component of an eye during a surgical procedure. A fenestration  102 , similar to that of FIG. 6A, is defined in a peripheral portion of the optic for insertion of an instrument to manipulate a lens within the eye.  
         [0047]    [0047]FIGS. 12A and 1212B show a lens  110  having an optic having three stems  112 ,  114 ,  116  extending generally radially from an optic. An anchor  118  extends from the optic and has a retaining shoulder  120 , whereby a suture  122  may be wound on and retained by shoulder  120  of the anchor.  
         [0048]    [0048]FIGS. 13A and 13B show a lens  130  having thee tapered generally rectilinear stems  132 ,  134 ,  136 , each having an opening therein. An anchor  138  is defined in a peripheral portion of the optic by two notches  140 ,  142  in the optic which taper inwardly and toward each other, as shown. A suture  144  may be wound about anchor  138  and extend therefrom for manipulation by a surgeon.  
         [0049]    [0049]FIGS. 14A and 14B show a lens  160  having an optic  162  having extending therefrom two stems  164 ,  166 , each having an opening therein for engagement by an instrument, and stem  168  having three openings  170  therein, and having a portion  172  extending generally parallel to an axis of the optic and another portion  174  extending from the end thereof and generally normal to the axis of the optic, similar to the stem  64  of the embodiment of FIG. 7A.  
         [0050]    [0050]FIGS. 15A, 15B show a lens  180  having three radially extending stems  183 ,  184 ,  186 , and a handle  188 , with five spaced-apart openings  190 , as shown. A portion  192  of the handle extends from the periphery of the optic and parallel to the axis thereof, and a second portion extends therefrom generally normal to the axis of the optic, thus to enable positioning thereof on a component of an eye in stable position during surgical procedures.  
         [0051]    [0051]FIGS. 16A, 16B show an embodiment  200  wherein an optic  201  has three stems  204 ,  206 ,  208  extending therefrom. A retainer  210  is defined in a peripheral portion of the optic by an opening  212  defined therein, as shown. The retainer is adapted to receive an instrument hook for manipulating the optic in the eye. This structure enables accurate, limited movement of the optic in the eye for relatively precise positioning, there being no outward extension of any member to effect any substantial leverage.  
         [0052]    It will be understood that various changes and modifications may be made from the preferred embodiments discussed above without departing from the scope of the present invention, which is established by the following claims and equivalents thereof.