Capsular membrane implants to increase accommodative amplitude

Abstract

A support is coupled to the lens capsule to increase accommodation. The support may be adjustable, such that patient refraction and accommodation can be adjusted following surgery. The support may comprise rigidity sufficient to decrease radial movement of the intermediate portion of the lens capsule. The support can be placed on the intermediate portion to decrease radial movement of the intermediate portion of the lens capsule and increase radial stretching of an outer portion of the lens capsule extending between the zonules and the intermediate portion coupled to the support, such that the amount of accommodation of the eye is increased. The support may comprise a biocompatible material capable of stable coupling to the lens capsule following implantation, such that the far vision refraction and accommodation of the eye can be stable following surgery.

What is claimed is: 
     
         1 . A method of treating an eye, the eye having a lens and a capsule, the method comprising:
 placing a support on an intermediate portion of the capsule to decrease radial movement of the intermediate portion and increase an amount of accommodation of the eye.   
     
     
         2 . The method of  claim 1 , wherein a peripheral portion of the lens capsule is coupled to the intermediate portion of the lens capsule and wherein radial movement of the peripheral portion is increased when the support is coupled to the intermediate portion. 
     
     
         3 . The method of  claim 1 , wherein a central portion of the lens capsule is coupled to the peripheral portion and wherein an anterior movement of the central portion is increased when the intermediate portion is coupled to the support. 
     
     
         4 . The method of  claim 1 , wherein the decreased radial movement comprises one or more of a stretching, a bending, a flexing, a translation or a rotation of the intermediate portion. 
     
     
         5 . The method of  claim 1 , wherein the eye has a first amount of accommodation prior to placement of the support on the eye and a second amount of accommodation when the support is placed on the intermediate portion of the capsule, the second amount greater than the first amount. 
     
     
         6 . The method of  claim 1 , wherein the capsule comprises one or more of an anterior capsule or a posterior capsule. 
     
     
         7 . The method of  claim 1 , wherein the portion comprises an intermediate portion of the lens capsule located between a peripheral portion of the lens capsule and a central portion of the lens capsule. 
     
     
         8 . The method of  claim 7 , wherein the peripheral portion is connected to zonules of the eye and the central portion corresponds to a center of a pupil of the eye, and wherein the intermediate portion of the capsule is coupled to the peripheral portion. 
     
     
         9 . The method of  claim 8 , wherein the lens comprises a natural lens of the eye and wherein the portion of the lens capsule comprises an anterior capsule having an anterior outer surface and wherein the support is adhered to the anterior outer surface of the intermediate portion to increase accommodation of the central portion. 
     
     
         10 . The method of  claim 9 , wherein the support is placed at least partially between the anterior capsule and the iris, the support comprising a thickness dimensioned such that the iris slides over the support when the iris contracts and dilates and wherein the support comprises a light absorbing material such that the support appears dark and appears as the pupil when the iris slides over the support. 
     
     
         11 . The method of  claim 10 , wherein the support comprise at least one curved surface corresponding to curvature of the lens and wherein the support comprises a thickness of no more than about 500 um. 
     
     
         12 . The method of  claim 10 , wherein the support comprises at least one flat surface. 
     
     
         13 . The method of  claim 9 , wherein the central portion of the lens capsule protrudes anteriorly from the support with an elevation of the central portion so as to increase a curvature of the anterior lens capsule when the eye accommodates. 
     
     
         14 . The method of  claim 13 , wherein the central portion of the lens capsule protrudes from the support with the elevation an amount greater than without the support and wherein the curvature of the central portion comprises an amount greater than the eye without the support. 
     
     
         15 . The method of  claim 9 , wherein the support comprises a substantially annular structure extending around the central portion so as to enclose the central portion and define an outer boundary of the central portion with the support and wherein the central portion comprises a protrusion extending anteriorly when the eye accommodates. 
     
     
         16 . The method of  claim 7 , wherein the support comprises an annular oval shape profile and wherein the intermediate portion comprises an annular oval portion coupled to the annular oval support to correct an astigmatism of the eye. 
     
     
         17 . The method of  claim 16 , wherein central portion comprises a toric shape profile when the eye accommodates to correct the astigmatism of the eye. 
     
     
         18 . The method of  claim 7 , wherein the intermediate portion comprises a toric shape profile. 
     
     
         19 . The method of  claim 9 , wherein the support extends substantially around the central portion so as to enclose the central portion and define an oval outer boundary of the central portion and wherein the central portion protrudes anteriorly from the oval outer boundary with an elevation and comprises a toric shape profile to correct the astigmatism when the eye accommodates. 
     
     
         20 . The method of  claim 9 , wherein the support extends substantially around the central portion so as to enclose the central portion and define an oval outer boundary of the central portion and wherein the central portion protrudes anteriorly from the oval outer boundary with an elevation and comprises a toric shape profile to correct the astigmatism when the eye accommodates. 
     
     
         21 . The method of  claim 7 , wherein the support is adhered to an anterior surface of an anterior capsule comprising the intermediate portion and wherein the support is used to guide removal of the central portion with a capsulorhexis to remove the central portion. 
     
     
         22 . The method of  claim 1 , wherein the lens comprises an accommodating IOL. 
     
     
         23 . The method of  claim 22 , further comprising removing a central portion of the lens capsule with a capsulorhexis, the removed central portion comprising a dimension across of at least about 4 mm and wherein the support comprises an inner dimension across of at least about 4 mm and wherein the capsule moves the peripheral portion radially inward toward the lens with a force of at least about 3 g. 
     
     
         24 . The method of  claim 22 , wherein the accommodating IOL has a haptic to move the IOL and wherein a structure of the support is aligned with the haptic to couple the structure to the haptic to increase the amount of accommodation. 
     
     
         25 . The method of  claim 1 , wherein support comprises a plurality of elongate segments passed through an incision and adhered on the lens capsule such that the support is assembled in situ within the eye. 
     
     
         26 . The method of  claim 1 , wherein the support comprises an annular structure having an inner diameter across and outer diameter across corresponding to a width of the annular structure and wherein the thickness comprises no more than about half of the width. 
     
     
         27 . The method of  claim 26 , wherein the annular structure comprises a ring. 
     
     
         28 . The method of  claim 26 , wherein the annular structure defines an aperture having a center and wherein the center is aligned with a pupil corresponding to a visual axis of the eye. 
     
     
         29 . The method of  claim 1 , wherein the support is adhered to the intermediate portion of the capsule and comprises a modulus of at least about 600 kPa, such that the support moves the peripheral portion inward radially when the eye accommodates. 
     
     
         30 . The method of  claim 29 , wherein the support comprises one or more of metal, nickel, titanium, nitinol, silicone, plastic, polypropeleyene, acryalte, ceramic or polycarbonate. 
     
     
         31 . The method of  claim 29 , wherein the support is adhered with an adhesive, the adhesive comprising one or more of cyanoacrylate, temperature sensitive adhesive, thermoreversible adhesive, a curable adhesive, a patterned microstructure based adhesive, a glycoprotein based adhesive or a cross-linker such as a photosensitive crosslinker. 
     
     
         32 . The method of  claim 29 , wherein the support is adhered to the intermediate portion with mechanical coupling comprising one or more of clamping, locking, threads, bayonet mounting or mechanical force. 
     
     
         33 . The method of  claim 29 , wherein the support is adhered to the intermediate portion with tack welding. 
     
     
         34 . The method of  claim 1 , wherein the support comprises an adjustable support. 
     
     
         35 . The method of  claim 34 , wherein a dimension across the support is adjusted to adjust one or more of a refraction of the eye for far vision or an amount of accommodation of the eye. 
     
     
         36 . The method of  claim 35 , wherein the dimension across the support is increased to decrease myopia of the eye or increased to decrease hyperopia of the eye. 
     
     
         37 . The method of  claim 35 , wherein the support comprises a shape changing material and wherein the shape changing material is treated with energy to adjust a dimension across the support. 
     
     
         38 . The method of  claim 37 , wherein the shape changing material comprises a heat sensitive material and wherein the support is heated with light energy to stiffen the support when the support is coupled to the intermediate portion. 
     
     
         39 . The method of  claim 37 , wherein the shape changing material comprises one or more of a metal or a polymer. 
     
     
         40 . The method of  claim 37 , wherein the adjustable support comprises layers of polymer and wherein the layers of polymer are arranged in a progressively stiffer membrane such that inner layers comprise more stiffness than outer layers and wherein at least one inner layer is severed so as to release an amount of contractual force increase the dimension across the support. 
     
     
         41 . The method of  claim 43 , wherein the at least one layer is severed with one or more of laser energy, laser pulses, Nd:YAG laser pulses, femto second laser pulses or mechanical cutting. 
     
     
         42 . The method of  claim 34 , wherein the support is treated with light energy to weaken the support when the support is coupled to the intermediate portion. 
     
     
         43 . The method of  claim 1 , wherein the support comprises an oval support and wherein a long dimension of the oval is aligned with an axis of an astigmatism of the eye to correct the astigmatism of the eye. 
     
     
         44 . The method of  claim 1 , wherein spherical aberration of the eye is decreased with the support placed on the intermediate portion. 
     
     
         45 . The method of  claim 1 , wherein the support comprises a structure having protrusions separated by a distance dimensioned to receive the portion of the lens capsule. 
     
     
         46 . The method of  claim 45 , wherein the structure comprises a channel and wherein the protrusions comprise rims extending circumferentially around the support, each rim having an inner surface to contact the portion of the capsule, the distance extending between the inner surfaces of the rims. 
     
     
         47 . The method of  claim 45 , wherein the intermediate portion of the capsule is introduced between the protrusions to couple the intermediate portion to the support. 
     
     
         48 . The method of  claim 1 , wherein an adhesive is positioned on the intermediate portion in an annular pattern and wherein the adhesive is hardened on the intermediate portion of the capsule such that the support comprises hardened adhesive and wherein the glue sticks to the intermediate portion when hardened to couple the support to the peripheral portion. 
     
     
         49 . The method of  claim 1 , wherein the support comprises a first elongate narrow profile through an insertion in a cornea of the eye of no more than about 2 mm, and wherein the support is expanded to a wide profile configuration and coupled to the intermediate portion of the lens capsule when the support comprises the expanded wide profile configuration.