fig1 shows the basic schematics of the anterior part of the human eye . note that in this particular example the eye is likely un - accommodated because the zonules are tense and the lens slightly flattened . behind the cornea of the eye 1 is the anterior chamber 2 the iris 3 and the sclera 4 . the posterior chamber 5 is the space between the iris and the capsular bag 6 which contains the natural lens 7 . the sulcus 8 is positioned between the iris and the ciliary body 9 , wherein its width is indicated by the arrow 10 and is connected to several groups of zonules 11 and also includes the ciliary muscle . the arrow 12 indicates the distance over which the zonules can be collapsed . fig2 and 3 show schematic views of the anterior part of the eye with an aiol with flanges 13 positioned in the sulcus . the rim of the haptic of the accommodating intraocular lens 14 is in contact with the ciliary body . the haptic is connected via a connector 15 to either the posterior element 16 or the anterior optical element 17 . note that complex surfaces which form a lens of variable optical power are schematically represented by two slanting surfaces on the inner side of each optical element . the capsular - rhexis 18 is the opening through which the natural lens is removed . the elastic connection spring which allows the optical element to shift has an opening 19 which is open when the lens is in an un - accommodated state of low dioptric power as shown in fig2 and closed when the lens is in an accommodated state of high dioptric power as shown in fig3 . in both figures , the rim of the haptics implanted anterior of the capsular bag has flanges 13 supporting the lens construction positioned in the sulcus . the length of the flanges is designed to position the rim of the optical elements of the aiol construction at the ciliary body to allow the ciliary muscle to shift the optical elements . fig4 shows a schematic of the anterior part of the eye with an aiol with additional posterior flanges 20 , additional to the anterior flanges illustrate in fig2 and 3 to support positioning and embracing the ciliary body . fig5 shows a schematic view of the anterior part of the eye with an aiol as in earlier figures but without a basic refractive optics in combination with a basic refractive lens 21 implanted separately in the capsular bag . this lens can be either of fixed optical power or , alternatively , an adjustable lens . the relaxed state , or the un - accommodated , is shown ; the accommodated state follows fig3 . fig6 shows a schematic view of the eye with an aiol with flanges and a posterior optical element which also carries basic refractive optics in combination with a third optical element 22 , in this exemplary embodiment , an element with such a shape that movement of this element ( for example , shift or rotation ) results in a variable lens , in combination with an optical surface on any of the other optical elements of the accommodative lens . fig7 shows a schematic view of the eye with an aiol with flanges and a posterior basic refractive optics in combination with a third optical element 23 , in this exemplary embodiment , a lens of fixed optical power which can be adjustable . in this exemplary embodiment , a plano - convex lens is fitted into an enclosure with holding means 24 . fig8 shows a schematic outline of the aiol with flanges for positioning in the sulcus , seen from above . note that all accommodating lenses described hereinabove can also have the option to correct for aberrations of the overall optics of the eye , for example , astigmatism . a number of exemplary embodiments for positioning as well as adjustability will be outlined hereinbelow . however , it will be clear to one of ordinary skill in the art that other embodiments for positioning in the sulcus of the eye of an aiol as well as adjustability post - implant of any iol , including any aiol , within the scope of the appended claims may be devised . one exemplary embodiment ( shown in fig2 and 3 ) for positioning of the aiol described in the sulcus has flanges 13 which extend from the base plate of the anterior element of the aiol . the flanges have the appropriate width to ensure proper fit in the sulcus and have the appropriate length to ensure that the ciliary body is in contact with the rim 14 of the main body of the aiol . at accommodation ( fig3 ), the ciliary body and , to a degree , the sulcus , will move the optical elements of the aiol to a position of higher optical diopter power compared to the relaxed state ( fig2 ). in a second exemplary embodiment ( fig4 ), similar flanges extend from both the anterior element as well as the posterior element , with flanges 20 . in this exemplary embodiment , the ciliary body is enclosed by the four flanges and a transfer of force and movement of both ciliary body and the sulcus is ensured . both exemplary embodiments have already shown to be simply manufactured by a straightforward addition to the milling program to extend the base plate to form the flanges . clearly , such lenses can comprise other constructions to extend the flanges , for example , extension of base plates by metal inserts , additional components , and so forth , but such additional components appear to be complex solutions to the same effect . firstly , one exemplary embodiment comprises the addition of an adjustable ( for example , a light adjustable miol lens to the accommodative lens , resulting in an aaiol system ( see , for example , international patent publication no . wo 03 / 058287 ). fig5 shows the addition of such an adjustable miol in the capsular bag . clearly , the refractive power of the aiol must be reduced in case of such addition and the power of the refractive unit . secondly , not illustrated , such an adjustable lens can be directly attached to the posterior or anterior element of the aiol by gluing or by a number of mechanical means . post - surgery adjustment of the adjustable lens provides an aaiol which ensures emmetropia of the eye . note that such adjustments are reversible and that such adjustments can be repeated several times . the aiol of the present disclosure changes the optical power of a lens formed by two optical elements which move perpendicular to the optical axis . such a concept can be applied to add adjustability to the aiol as well . a third optical element 22 ( fig6 ) is added to the aiol , of which at least one surface forms a variable lens in combination with an additional surface on any of the surfaces of the aiol . the lens varies in optical power by either shift of the third element or , alternatively , by rotation over an axis , with the third element preferably connected to the aiol by an elastic connection . alternatively , such third element 23 can be added to the aiol by holding means ( in an enclosure ) 24 . such ( occasional , adjusting ) shift or rotation of the third element is most likely achieved by interference by an eye surgeon by moving the element in the eye by , for example , a surgical needle or forceps , through a small incision . however , electro - mechanical or magnetic or optical ( by , for example , a surgical laser ) options for such movement are possible with adaptations to the aiol system . most simply , at least one holding means ( in this example , partial enclosure ) 24 ( fig7 ) formed , in this example , by a rim or , alternatively , by at least two clamps can be designed to either partially enclose a low power miol or partially enclose an adjustable low power miol ( or a third element with a complex optical surface which works in combination with an additional surface on the aiol , as set forth hereinabove ). such miol or third element can be added before surgery ( at the manufacturing stage ), during surgery , or post - surgery ( at any time ). such miol can be of a low positive or low negative power ( for example , in the range of − 2d to + 2d ), depending on requirements . such miol can be thin (˜ 100 - 200 um thick ) ensuring simple surgery through a small incision and hardly add to the thickness of the anterior optical element of the aaiol ( as shown in fig7 ). all patents , patent applications , publications and other documents referred to herein are incorporated by reference in their entirety .
an accommodating intraocular artificial lens with variable optical power , comprising two optical elements which are adapted to mutually shift in a direction perpendicular to the optical axis wherein the optical elements have such a shape that the optical elements exhibit , in combination , different optical powers at different relative positions . flanges are adapted to position the anterior section of the haptics in the sulcus of the eye or , alternatively , the ciliary body is enclosed by a combination of anterior and posterior flanges . also disclosed are methods to provide for an accommodating intraocular lens which is adjustable post - implant to ensure emmetropia of the eye .