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A change of the refractive power of 3 dpt and a postoperative correction of refraction shall be realized. Envisaged solutions for the optical element  are shown in image 2. On the left a three lens system called triple-optics is depicted.
The outer auxiliary lenses provide the basic refractive power while the shift of the middle lens along the optical axis allows for the adaption of refractive power. The second lens system is a so-called Alvarez-Humphrey-lens AH-lens. Here, the change of refractive power is realized by a lateral displacement of the components relative to each other. The auxiliary lenses for the provision of the basic refractive power of the lens and the compensation of aberrations can be integrated into the outer shape of the lens components.
The third option is the use of a fluidic lens. Hereby, a meniscus is formed between two fluids of different refractive indices. Changing the form of this meniscus by fluid displacement changes the refractive power of this fluidic lens. The basic refractive power is provided by an additional auxiliary lens.
The displacement or deformation of the lenses is realized by an actuator system. In order to determine the current accommodation demand a sensor system is used.
Another way to determine the accommodation demand is to measure the pupil width and the ambient luminance . Therefore, a photo sensor array must be placed as close as possible behind the pupil. Beside the optical element, the actuator system and the sensor system further components have to be integrated into the lens implant.
These are a communication unit for data exchange between the implants but also with the ophthalmologist, a control unit and energy supply. Image 2 Envisaged solutions for the optical element of the Artificial Accommodation System. The system shall be implanted into the capsular bag by standard cataract surgery methods. Thereof, the optical element occupies the inner circle of 5 mm diameter. First implantation studies show that the implant diameter needs to be further reduced and the outer geometry has to be modulated rather lens-shaped than cylindrical.
This complicates the integration of electronic and mechanical components in the outer ring of the implant . The Artificial Accommodation System has to be biocompatible and must withstand all forces applied during manufacturing, implantation and operation. In order to allow wireless loading and communication, the encapsulation of the implant must allow electromagnetic transmission. In the optical area the encapsulation must be transparent for visible light and IR-lasers for treatment of posterior capsular opacity .
For a lifetime of more than 30 years no aqueous humour must enter the interior of the implant. Thus, the human body is protected from contact with the substances contained within the system and corrosion and loss of functionality of the components is prevented. Therefore, the dew point rises and ppm v water can be tolerated. Even if starting at 0 ppm v the allowed maximum rate of water intrusion over a lifetime of 30 years is only 9.
Consequently, hermeticity of the encapsulation has to be guaranteed. In  solutions for the different subtasks of system integration are investigated.
For the interconnect device a flexprint is chosen. In order to fixate the implant within the eye, the outer geometry of the implant in combination with additional haptics can be used. To encapsulate the system, two solutions are identified to be suitable: glass housing and polymer casting.
Now, these single solutions have to be combined to a comprehensive system integration concept. Thereby, the individual requirements of the integrated components have to be regarded. Polymer lenses in a gas environment can be used in form of a triple-optics or an AH-lens. In order to guarantee the S maintenance of a gas-filled cavity in the optical area over the entire lifetime, a hermetic encapsulation is necessary. Therefore, a glass housing must be used.
This housing can either package the entire system or only be applied to the optical area as shown in image 3. For the latter approach the components in the ring-shaped volume around the optical area would be coated and then casted with polymer.
The overall hermetic package is favoured since it protects all components of the implant from the contact with body fluid. The thinner wall thickness of the polymer casting in the outer ring is of no advantage, since it is compensated by the additional wall thickness of the glass housing for the optical area. Furthermore, a sealed transfer of the motion of the actuator through the glass is necessary.
The remaining advantage of this concept is a higher flexibility in the outer area and consequently better implantability of the system. Image 3 Concept of separate housing for the optical element. Polymer lenses in aqueous humour can only be applied in form of the AH-lens. An application of the triple-optics would result in too high displacement forces due to the necessary lens shift against a fluid along the optical axis.
Only the components in the outer ring around the lens are encapsulated. The transfer of the motion of the actuator to the lens component in the optical area can be realized using an elastically sealed mechanical conduct.
Alternatively, the actuator can be fully placed into the aqueous humour being supplied with the necessary electrical energy. A hermetic encapsulation is not obligatory if the contact of the internal components with body fluid can be reliably prevented otherwise, like with the help of additional coating. Polymer casting can be applied with thinner wall thicknesses than glass housings. For the operation of the optical element in aqueous humour, however, the mass of the movable lens part and its range of displacement must be wider due to the small difference of refractive indices between water and polymer .
Thus, additional energy and hence bigger actuator and battery are necessary than for an AH-lens operated in a gas environment. In order to use fluidic lenses, a separate glass housing is necessary that protects the fluids from drying out and the internal electronic components from the contact with the fluids.
The fluids have to be connected with a micro pump or a piston that performs the displacement of the fluids image 2 and 4. The manufacturing and bubble-free filling of the housing for a fluidic lens is very demanding . In comparison with the other optical elements, the additional volume used by a separate housing is a great disadvantage of the fluidic lens. Thus, its use is only advisable in case the additional volume for the housing is compensated by a respectively smaller actuator.
For the time being, this optical element is not regarded further. Possibly, a reduction of the wall thickness of the housing can be realized. The very low dissipation power does not harm the organism. These advantages apply to every electronic or mechatronic micro system housed by a rigid material. Image 4 Concepts to encapsulate a fluidic lens with hermetic housing of the lens and A polymer casting or B additional housing of the outer component ring. Image 5 Internal polymer casting used as getter material.
To guarantee a hermetic sealing of the joining of the individual housing parts for 30 years, however, is still a challenge, especially when low-temperature bonding processes have to be used. One aspect in case of failure of the encapsulation and consequent contact of the internal components with body fluid is corrosion and system failure. Another aspect is the influence on the refractive power of the optical element.
The lenses are designed to be operated in gas. While a rise of the relative humidity of the gas has no considerable influence on the refractive power, liquid water would lead to extreme hyperopia. Depending on the chosen optical element and its current lens position the vision can be impaired by 8. Thus, it is advisable to take additional safety measures.
The encapsulation using glass housings is extended by internal polymer casting. Next to this, a protective coating can be applied to the internal components. Although for these measures additional production processes are necessary and the mass of the implant is increased, the advantages are substantial in case of failure of the encapsulation.
Thus, the rise of relative humidity inside the gas-filled cavity for the optical component is delayed. Favoured comprehensive system integration concepts Now, all elements of the system integration can be combined into comprehensive system integration concepts.
Thereby, the subsystems optical element, actuator system, sensor system, communication unit, control unit and energy supply form a functional overall system and all subtasks of system integration are being fulfilled. The three favourite comprehensive integration concepts are shown in image 6. They differ in the form of encapsulation and the integrated optical element. The interconnect device is a flexprint for all three concepts .
In concept 1 and 2 the implant is encapsulated using glass housings with internal polymer casting and coating of the internal components.
The hermetic housing allows for a gas-filled cavity and therefore high differences of refractive indices between the lenses and their environment. In concept 1 an AH-lens is used as optical element, in concept 2 a tripleoptics. The haptics are separate elements that are mounted using casting or a special retainer. In concept 3 an AHlens is operated in aqueous humour while all other components are encapsulated by polymer casting, protected by a hermetic coating.
The lens shape is adapted to the small differences of refractive indices between polymer lens and aqueous humour. The call button must be red and lit up when dark. This applies cor- respondingly to all other rooms in which pati- ents could be found. The call release must be indicated optically in the call button or in the immediate vicinity by means of a reassurance lamp. Call buttons in bathrooms must be spe- cially designed for this environment. Presence Marking of the presence of care personnel by In all rooms in which the personnel should means of a presence button when entering a be contactable by calls, the presence marking room connected to the call system must be switched on through operation of the presence button or through automatic logging.
The presence button must be green; the state of the switch should be indicated optically within the button or next to it. It should be positi- oned near the door.
The presence button — if there is one — for a second group of person- nel may be yellow. Emergency call Call by a carer, with which assistance from The release of an emergency call is prepared another carer is summoned by switching on presence. The call in the room becomes an emergency call. Non-answerable calls Call from a device without speech possibility. Calls without speech communication must The call location must be visited. Only call acknow- ledgement is permissible if the call response is monitored by the system.
Bed call Call by a patient from the call equipment by Malfunctions that can affect the release, the bed that can be selectively recognised transmission and indication of calls must be reported. The relevant Application Area should be taken into account. Telephone call A call released from a telephone extension in Normally, a call to the duty room telephone the case of absence is forwarded via the call system in the case of absence.
Call forwarding Forwarding of a call to the location where pre- Call forwarding is required when the call sys- sence has been marked by the care personnel. The call is acoustically indicated as a mini- mum. In addition, the call location and the call type can be indicated. Answerable calls may be cancelled after a speech connection auxiliary answering. Call cancellation Termination of the call state by setting of The installation locations of the equipment marked presence by means of a cancel button with presence button and the cancel button or by remote answering within the framework should be specified.
Bed-by-bed speech Each bed is supplied with a speech device and can be addressed individually Room terminal Operating and communications unit in Room terminals are usually provided for patient rooms and function rooms all sickrooms and function rooms.
They can contain the operational elements and indicator displays as well as the auxiliary call answering for systems with speech. Important: Do not connect power supply units in parallel. A new voltage line must be installed for each further power supply unit in the system.
Parallel switching of power supply units is not permissible!
A voltage signal on the input triggers a system call call type and location of signalisation can be selected as desired. The outputs respond to a call from the system. Here as well, the call type and location of signalisation can be selected as desired. Function of output: see device label. In reality the network cables are installed flushmounted and the components interconnected via network connection boxes.
For all devices these numbers have 7 digits example ID:. The first 2 digits describe the device type. In the following example, 72 means that this concerns a room module. The next 5 digits represent the individual device number, assigned during device production. Each system device has 2 coherent labels printed with the same ID.
One of the labels is firmly stuck to the device, the second is stuck but can be removed and attached to the ward plan.
ID ZM ID ZM Figure Device labels with device ID for sticking into the ward plan Sticking one of the two labels onto the ward plan makes parameterisation with the configuration software easier, as the software recognises the device but not its installation site.
Which device was installed at which location and in which room must be entered into the software with the aid of the ward plan. Bett 1 z. Bett 2 z. Bett 3 z. The registering process for devices in the system may require up to 5 minutes with a large system. After the central unit has recognised the system devices, these are then automatically monitored. The system devices can now be parameterised with the configuration assistant.
Failed devices are immediately displayed in the system. Subsequent integration of devices is possible at any time. Removing devices from the system Procedure: First physically remove the device from the system. Then this device must also be removed from the configuration assistant software.
With the aid of the configuration assistant, the room control unit is linked to the duty room terminal CT9. The devices are then functionally interconnected. The "nurse call system Plus LAN" network connection interconnects the devices of a call system via an Ethernet switch. The "external LAN" network connection is for connection to an external PC for configuring the call system or to an external hospital network or for connection to a time server on the Internet.