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EP-3781101-B1 - SYSTEMS FOR IMPROVING VISION FROM AN INTRAOCULAR LENS IN AN INCORRECT POSITION AND USING REFRACTIVE INDEX WRITING

EP3781101B1EP 3781101 B1EP3781101 B1EP 3781101B1EP-3781101-B1

Inventors

  • ROSEN, ROBERT
  • Gounou, Franck Emmanuel
  • CANOVAS VIDAL, CARMEN
  • ALARCON HEREDIA, Aixa

Dates

Publication Date
20260506
Application Date
20200403

Claims (11)

  1. A system for improving vision of a subject with an implanted intraocular lens, IOL, the system comprising: at least one sensor (210) configured to sense a tilt of at least one optical element relative to a reference line corresponding to alignment of the apex of the cornea, center of the pupil, center of the IOL, and fovea, wherein the tilt produces an imperfection in foveal vision in the subject; and a control system (204) operatively coupled to the at least one sensor and configured to receive associated sensed data corresponding to the tilt and to calculate, based at least on the sensed data: a multi-layered phase change pattern to produce on the IOL, that is configured to compensate for the tilt by induction of a left-right asymmetry in multiple layers that have a prismatic effect to improve the foveal vision of the subject; a pattern comprised of a plurality of pulses of radiation to apply to the IOL to produce the phase change pattern; and one or more selected areas of the IOL to which the plurality of pulses are to be applied; a pulsed radiation system (202) operatively coupled to the control system and configured to, based on control by the control system, apply the plurality of pulses of radiation to the IOL according to the pattern to produce, by refractive index writing on the IOL, the phase change pattern on the IOL that is configured to compensate for the tilt to improve the foveal vision of the subject.
  2. The system of claim 1, wherein the pulsed radiation system comprises a pulsed laser and is configured to apply a plurality of laser pulses to the one or more selected areas of the IOL, according to the pattern comprised of the plurality of pulses, to produce the phase change pattern.
  3. The system of claim 1 or 2, wherein the control system is configured to determine the phase change pattern based at least in part on biometrics associated with at least one of: IOL positioning; axial length; corneal power; and refraction.
  4. The system of claim 3, wherein the biometrics associated with IOL positioning comprise measurements of at least one of effective lens position (ELP), tilt, and decentration of the IOL.
  5. The system of claim 3, wherein the biometrics associated with the corneal power comprise keratometry.
  6. The system of claim 3, wherein the biometrics associated with the corneal power comprise elevation maps.
  7. The system of any one of claims 1-6, wherein the system is configured to determine the tilt using Purkinje imaging.
  8. The system of any one of claims 1-7, further comprising an optical coherence tomography (OCT) system configured to determine the tilt.
  9. The system of any one of claims 1-8, wherein the system is configured to determine the phase change pattern using, at least in part, ray-tracing simulation.
  10. The system of any one of claims 1-9, wherein the control system is configured to calculate the pattern according to which the pulses of radiation are applied based at least in part on the tilt.
  11. The system of any one of claims 1-10, wherein the at least one sensor is further configured to sense a deviation in position of at least one optical element from the reference line, wherein the deviation in position produces an imperfection in foveal vision in the subject; wherein the control system is configured to receive associated sensed data corresponding to the deviation in position and calculate the phase change pattern to compensate for the deviation.

Description

BACKGROUND Currently a range of factors can limit visual performance of a patient (also referred to herein as a "subject") following corrective surgery (e.g., cataract surgery) in which an intraocular lens (IOL) is implanted in the patient's eye(s). These limiting factors can include: incorrect IOL power, which is commonly caused by incorrect IOL power calculations due to biometry accuracy; and uncorrected astigmatism, which can be caused by factors such as surgically induced astigmatism, effect of posterior corneal astigmatism, incorrect toric IOL power calculation, toric IOL rotation, or misplacement and use of non-toric IOLs in toric corneas. Additional limiting factors can include: spectacle dependence, which can be due to monofocal IOL implantation, as well as incorrect estimations of the most suitable presbyopia correcting IOLs for the patient; photic phenomena, such as halos, starburst and glare, for example in patients using presbyopia-correcting IOLs; negative dysphotopsia; peripheral aberration, and chromatic aberration. Replacing an implanted IOL that causes negative post-surgical visual outcomes for a patient can be a risky and complicated procedure. Therefore, among other needs, there exists a need to alleviate negative post-surgical visual outcomes without the need of IOL replacement. US2017027437A1 relates to an optical measurement system and apparatus for carrying out cataract diagnostics in an eye of a patient includes a Corneal Topography Subsystem, a wavefront aberrometer subsystem, and an eye structure imaging subsystem, wherein the subsystems have a shared optical axis, and each subsystem is operatively coupled to the others via a controller. The eye structure imaging subsystem is preferably a fourierdomain optical coherence tomographer, and more preferably, a swept source OCT. US2018200112A1 relates to systems and methods for localizing intraocular lens and/or existing refractive index patterns, to laser write-patterns, and to refractive index patterns in order to modify the refractive index by application of femtosecond laser pulses. OCT-based confocal detection and sectional image systems are provided for localization purposes, the systems being particularly suitable for the detection of phase patterns in addition to the localization of the IOL. With respect to laser write-patterns, the modification of existing refractive index patterns in the IOL is carried out by destroying existing structures or supplementing existing refractive index patterns. US2010082017A1 relates to a system of modifying an intraocular device located within an eye, wherein the system includes a laser assembly and a controller coupled to the laser assembly. The laser assembly outputs a pulsed laser beam having a pulse width between about 300 picoseconds and about 10 femtoseconds, and the controller directs the laser assembly to output the pulsed laser beam into the intraocular device. One or more slip zones are formed within the intraocular device in response thereto, and the slip zones are configured to modify a refractive profile of the intraocular device. A method of modifying a refractive profile of an eye having an intraocular device implanted therein, wherein the method includes determining a corrected refractive profile for the eye based on an initial refractive profile, identifying one or more locations within the intraocular device based on the corrected refractive profile, and directing a pulsed laser beam at the locations to produce the corrected refractive profile. US2009036880A1 relates to a device for altering an optical and/or mechanical property of a lens that is implanted in an eye, the device including a laser device, which has a laser beam source that provides a pulsed laser beam and an optical unit, which impinges on the implanted lens with the pulsed laser beam. The device also includes a control device, which controls the laser device such that the optical and/or mechanical property of the lens is altered on the basis of nonlinear interaction between the laser beam and the lens material. US2019021904A1 relates to a system for ophthalmic surgery includes a laser source configured to deliver an ultraviolet laser beam comprising laser pulses having a wavelength between 320 nm and 370 nm to photodecompose one or more intraocular targets within the eye with chromophore absorbance. The pulse energy, the pulse duration, and the focal spot are such that an irradiance at the focal spot is sufficient to photodecompose the one or more intraocular targets without exceeding a threshold of formation of a plasma and an associated cavitation event. An optical system operatively coupled to the laser source and configured to focus the ultraviolet laser beam to a focal spot and direct the focal spot in a pattern into the one or more intraocular targets. The optical system focuses the laser beam at a numerical aperture that provides for the focal spot to be scanned over a scan range of 6 mm to 10 mm. SUMMARY