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Wolffsohn JS, Naroo SA, Bullimore MA, Craig JP, Davies LN, Markoulli M, Schnider C, Morgan PB. BCLA CLEAR Presbyopia: Definitions. Cont Lens Anterior Eye 2024; 47:102155. [PMID: 38609792 DOI: 10.1016/j.clae.2024.102155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Presbyopia is often the first sign of ageing experienced by humans. Standardising terminology and adopting it across the BCLA CLEAR Presbyopia reports, improves consistency in the communication of the evidence-based understanding of this universal physiological process. Presbyopia can be functionally and psychologically debilitating, especially for those with poor access to eyecare. Presbyopia was defined as occurring when the physiologically normal age-related reduction in the eye's focusing range reaches a point that, when optimally corrected for far vision, the clarity of vision at near is insufficient to satisfy an individual's requirements. Accommodation is the change in optical power of the eye due to a change in crystalline lens shape and position, whereas pseudo-accommodation is the attainment of functional near vision in an emmetropic or far-corrected eye without changing the refractive power of the eye. Other definitions specific to vision and lenses for presbyopia were also defined. It is recommended that these definitions be consistently adopted in order to standardise future research, clinical evaluations and education.
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Affiliation(s)
- James S Wolffsohn
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom.
| | - Shehzad A Naroo
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
| | | | - Jennifer P Craig
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand
| | - Leon N Davies
- College of Health & Life Sciences, Aston University, Birmingham, United Kingdom
| | - Maria Markoulli
- School of Optometry & Vision Science, University of New South Wales, Sydney, Australia
| | - Cristina Schnider
- Eurolens Research, Division of Pharmacy and Optometry, University of Manchester, United Kingdom
| | - Philip B Morgan
- Eurolens Research, Division of Pharmacy and Optometry, University of Manchester, United Kingdom
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Wolffsohn JS, Davies LN, Sheppard AL. New insights in presbyopia: impact of correction strategies. BMJ Open Ophthalmol 2023. [DOI: 10.1136/bmjophth-2022-001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Presbyopia occurs when the physiologically normal age-related reduction in the eyes focusing range reaches a point, when optimally corrected for distance vision, that the clarity of vision at near is insufficient to satisfy an individual’s requirements. Hence, it is more about the impact it has on an individual’s visual ability to function in their environment to maintain their lifestyle than a measured loss of focusing ability. Presbyopia has a significant impact on an individual’s quality of life and emotional state. While a range of amelioration strategies exist, they are often difficult to access in the developing world and prescribing is generally not optimal even in developed countries. This review identified the need for a standardised definition of presbyopia to be adopted. An appropriate battery of tests should be applied in evaluating presbyopic management options and the results of clinical trials should be published (even if unsuccessful) to accelerate the provision of better outcomes for presbyopes.
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Evaluation of a Novel Zonular Tension Restoring Accommodating Silicone IOL Design: Pilocarpine and Cyclopentolate-Induced Effect 20 Months after Implantation. J Ophthalmol 2021; 2021:4797851. [PMID: 34881053 PMCID: PMC8648478 DOI: 10.1155/2021/4797851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate a novel zonular-stress restoring accommodating 1-piece silicone IOL. Setting. Angeles City, Philippines. Design Prospective randomized bilateral study. Methods Each patient received a study IOL (ActaLens™, Emmetrope, La Canada, CA) in one eye and a control IOL (CrystaLens® AO, B&L, USA, or an AcrySof IQ®, Alcon, USA) in the contralateral eye to allow for intraindividual comparison. At the 20-month follow-up, two measurement days were set to measure all eyes before and after instilling 2% pilocarpine on the first day and 1% cyclopentolate on the second measurement day using an optical biometry device (Lenstar, Haag-Streit AG, Switzerland), respectively. PCO was graded by two examiners independently at the slit lamp. Results In total, 16 eyes of 8 patients were included. In the study group and the control group, the pilocarpine-induced ACD shift was 0.32 mm (SD: 0.12) (p=0.014) and 0.04 mm (SD: 0.16) (p=0.854), respectively. In the study group and the control group, the mean cyclopentolate-induced ACD shift was 0.14 (SD: 0.06) (p=0.014) and 0.03 mm (SD: 0.03) (p=0.181), respectively. PCO and Nd : YAG rates were higher in the study group, but differences were not found to be significant (AcrySof vs. ActaLens p=0.100 and CrystaLens vs. ActaLens p=0.174). Conclusion The investigated IOL is a novel concept for an accommodating IOL, and results showed a moderate pilocarpine-induced forward shift of the IOL 20 months following implantation. For all patients, the investigated IOL seems to have a higher PCO rate compared to standard monofocal IOLs.
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Factors Influencing Pseudo-Accommodation-The Difference between Subjectively Reported Range of Clear Focus and Objectively Measured Accommodation Range. Vision (Basel) 2019; 3:vision3030034. [PMID: 31735835 PMCID: PMC6802792 DOI: 10.3390/vision3030034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/06/2019] [Accepted: 06/20/2019] [Indexed: 02/07/2023] Open
Abstract
The key determinants of the range of clear focus in pre-presbyopes and their relative contributions to the difference between subjective range of focus and objective accommodation assessments have not been previously quantified. Fifty participants (aged 33.0 ± 6.4 years) underwent simultaneous monocular subjective (visual acuity measured with an electronic test-chart) and objective (dynamic accommodation measured with an Aston open-field aberrometer) defocus curve testing for lenses between +2.00 to −10.00 DS in +0.50 DS steps in a randomized order. Pupil diameter and ocular aberrations (converted to visual metrics normalized for pupil size) at each level of blur were measured. The difference between objective range over which the power of the crystalline lens changes and the subjective range of clear focus was quantified and the results modelled using pupil size, refractive error, tolerance to blur, and ocular aberrations. The subjective range of clear focus was principally accounted for by age (46.4%) and pupil size (19.3%). The objectively assessed accommodative range was also principally accounted for by age (27.6%) and pupil size (15.4%). Over one-quarter (26.0%) of the difference between objective accommodation and subjective range of clear focus was accounted for by age (14.0%) and spherical aberration at maximum accommodation (12.0%). There was no significant change in the objective accommodative response (F = 1.426, p = 0.229) or pupil size (F = 0.799, p = 0.554) of participants for levels of defocus above their amplitude of accommodation. Pre-presbyopes benefit from an increased subjective range of clear vision beyond their objective accommodation due in part to neural factors, resulting in a measured depth-of-focus of, on average, 1.0 D.
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Barišić A, Patel S, Gabric N, Feinbaum CG. The clinical depth of field achievable with trifocal and monofocal intraocular lenses: theoretical considerations and proof of concept clinical results. Graefes Arch Clin Exp Ophthalmol 2016; 255:367-373. [PMID: 28013392 DOI: 10.1007/s00417-016-3566-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 10/07/2016] [Accepted: 11/29/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To estimate the depth of field (DOF) achievable with multi-and monofocal intraocular lenses (IOLs) and compare with actual measurements of DOF in cases implanted with a trifocal IOL and biconvex monofocal IOL METHODS: I) Computer simulations were produced to describe the relationship between DOF, pupil size, preoperative ametropia, and retinal blur tolerance limit for a model eye implanted with either multi- or monofocal IOLs. II) Monocular DOF and pupil size were measured under distance viewing conditions between 3 and 6 months postoperative following uneventful cataract surgery. Cases were implanted with either i) trifocal aspheric IOL (n = 36), or ii) biconvex aspheric monofocal IOL (n = 26). DOF was also measured at 0.33 m in cases implanted with i). RESULTS Simulations revealed significant associations between DOF, pupil size, and retinal blur tolerance limit. The mean (±SD) DOF & pupil sizes were at distance for i) above 2.59D (0.68) & 3.54 mm (0.377), and for ii) above 1.67D (0.51) & 2.90 mm (0.351), and for i) above 3.16D (0.46) at near. The difference between groups were significant for DOF and pupil size at distance (p < 0.001). DOF was significantly greater at near compared with distance in i) above (p < 0.001). For a pupil size of 3 mm, the simulations produce similar DOF values when the tolerance limit of retinal blur is 10 μ. CONCLUSIONS The DOF was significantly better after implanting the trifocal IOL compared with the monofocal IOL, and DOF is increased under near viewing conditions. The clinical results are similar to calculated DOF values when the tolerance limit of retinal blur is 10 μ.
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Affiliation(s)
- Ante Barišić
- Special Eye Hospital Svjetlost, Heinzelova 39, 10000, Zagreb, Croatia.
| | - Sudi Patel
- Special Eye Hospital Svjetlost, Heinzelova 39, 10000, Zagreb, Croatia
- NHS National Services Scotland, Edinburgh, UK
| | - Nikica Gabric
- Special Eye Hospital Svjetlost, Heinzelova 39, 10000, Zagreb, Croatia
| | - Claes G Feinbaum
- Barzilai Hospital, BenGurion University of the Negev, BerSheeba, Israel
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Mao X, Banta JT, Ke B, Jiang H, He J, Liu C, Wang J. Wavefront Derived Refraction and Full Eye Biometry in Pseudophakic Eyes. PLoS One 2016; 11:e0152293. [PMID: 27010674 PMCID: PMC4806839 DOI: 10.1371/journal.pone.0152293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 03/12/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose To assess wavefront derived refraction and full eye biometry including ciliary muscle dimension and full eye axial geometry in pseudophakic eyes using spectral domain OCT equipped with a Shack-Hartmann wavefront sensor. Methods Twenty-eight adult subjects (32 pseudophakic eyes) having recently undergone cataract surgery were enrolled in this study. A custom system combining two optical coherence tomography systems with a Shack-Hartmann wavefront sensor was constructed to image and monitor changes in whole eye biometry, the ciliary muscle and ocular aberration in the pseudophakic eye. A Badal optical channel and a visual target aligning with the wavefront sensor were incorporated into the system for measuring the wavefront-derived refraction. The imaging acquisition was performed twice. The coefficients of repeatability (CoR) and intraclass correlation coefficient (ICC) were calculated. Results Images were acquired and processed successfully in all patients. No significant difference was detected between repeated measurements of ciliary muscle dimension, full-eye biometry or defocus aberration. The CoR of full-eye biometry ranged from 0.36% to 3.04% and the ICC ranged from 0.981 to 0.999. The CoR for ciliary muscle dimensions ranged from 12.2% to 41.6% and the ICC ranged from 0.767 to 0.919. The defocus aberrations of the two measurements were 0.443 ± 0.534 D and 0.447 ± 0.586 D and the ICC was 0.951. Conclusions The combined system is capable of measuring full eye biometry and refraction with good repeatability. The system is suitable for future investigation of pseudoaccommodation in the pseudophakic eye.
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Affiliation(s)
- Xinjie Mao
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - James T. Banta
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Bilian Ke
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
- Department of Ophthalmology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Jiang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Jichang He
- New England College of Optometry, Boston, Massachusetts, United States of America
| | - Che Liu
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Jianhua Wang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States of America
- * E-mail:
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Fully Automated Biometry of In Situ Intraocular Lenses Using Long Scan Depth Spectral-Domain Optical Coherence Tomography. Eye Contact Lens 2014; 40:37-45. [DOI: 10.1097/icl.0000000000000005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Comparison of near vision, intraocular lens movement, and depth of focus with accommodating and monofocal intraocular lenses. J Cataract Refract Surg 2013; 39:1872-8. [DOI: 10.1016/j.jcrs.2013.05.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Gillner M, Eppig T, Langenbucher A. Automatic intraocular lens segmentation and detection in optical coherence tomography images. Z Med Phys 2013; 24:104-11. [PMID: 23928353 DOI: 10.1016/j.zemedi.2013.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 07/13/2013] [Accepted: 07/15/2013] [Indexed: 11/25/2022]
Abstract
We present a new algorithm for automatic segmentation and detection of an accommodative intraocular lens implanted in a biomechanical eye model. We extracted lens curvature and position. The algorithm contains denoising and fan correction by a multi-level calibration routine. The segmentation is realized by an adapted canny edge detection algorithm followed by a detection of lens surface with an automatic region of interest search to suppress non-optical surfaces like the lens haptic. The optical distortion of lens back surface is corrected by inverse raytracing. Lens geometry was extracted by a spherical fit. We implemented and demonstrated a powerful algorithm for automatic segmentation, detection and surface analysis of intraocular lenses in vitro. The achieved accuracy is within the expected range determined by previous studies. Future improvements will include the transfer to clinical anterior segment OCT devices.
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Affiliation(s)
- Melanie Gillner
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nuremberg, Henkestr. 91, 91052 Erlangen, Germany; Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander University Erlangen-Nuremberg, Paul-Gordan-Str. 6, 91052 Erlangen, Germany.
| | - Timo Eppig
- Experimental Ophthalmology, Saarland University, Kirrberger Str. 100, Bldg. 22, 66421 Homburg, Germany
| | - Achim Langenbucher
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander University Erlangen-Nuremberg, Paul-Gordan-Str. 6, 91052 Erlangen, Germany; Experimental Ophthalmology, Saarland University, Kirrberger Str. 100, Bldg. 22, 66421 Homburg, Germany
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Ye PP, Li X, Yao K. Visual outcome and optical quality after bilateral implantation of aspheric diffractive multifocal, aspheric monofocal and spherical monofocal intraocular lenses: a prospective comparison. Int J Ophthalmol 2013; 6:300-6. [PMID: 23826522 DOI: 10.3980/j.issn.2222-3959.2013.03.08] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 04/22/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To evaluate the visual function after bilateral implantation of aspheric diffractive multifocal Tecnis ZMA00, aspheric monofocal ZA9003 versus spherical monofocal Akreos Adapt intraocular lenses (IOLs). METHODS Tecnis ZMA00, Tecnis ZA9003 or Akreos Adapt IOLs were bilaterally implanted in 180 eyes from 90 patients. The following parameters were assessed 3 months postoperatively: monocular and binocular uncorrected visual acuity (UCVA) and distance-corrected visual acuity (DCVA) for distance, intermediate and near, spherical aberration (SA), contrast and glare sensitivity, near point refractive power, uncorrected and best-corrected near stereoscopic acuity (NSA). Patient satisfaction was assessed by a questionnaire. RESULTS Three months postoperatively, the monocular and binocular UCVA and DCVA at near of Tecnis ZMA00 were significantly better than other two groups. The mean SA for 5.0mm optical zone in Tecnis ZMA00 and Tecnis ZA9003 was significantly lower than that in Akreos Adapt. Mean contrast sensitivity and glare sensitivity were better for Tecnis ZA9003 group than for other two groups. Patients with Tecnis ZMA00 had higher monocular and binocular near point refractive power and uncorrected NSA than monofocal groups. The patients in Tecnis ZMA00 had higher mean values for halo compared with other two groups. CONCLUSION Tecnis ZMA00 provided better near VA and uncorrected NSA and higher near point refractive power than monofocal IOLs and patients were spectacle independent. The IOLs with Tecnis aspheric design improved contrast and glare sensitivity. Patients with Tecnis ZMA00 reported more disturbances on visual phenomena of halo.
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Affiliation(s)
- Pan-Pan Ye
- Eye Center, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 3100009, Zhejiang Province, China
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Eppig T, Gillner M, Zoric K, Jäger J, Löffler A, Langenbucher A. Biomechanical eye model and measurement setup for investigating accommodating intraocular lenses. Z Med Phys 2013; 23:144-52. [PMID: 23474131 DOI: 10.1016/j.zemedi.2013.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/13/2013] [Accepted: 02/13/2013] [Indexed: 11/17/2022]
Abstract
We present a biomechanical eye model to induce pseudophakic accommodative movement for evaluation of the focal shift of accommodative intraocular lenses. Therefore, an accommodative intraocular lens (IOL) was implanted into freshly enucleated porcine eyes. The eyes were glued into a mechanical apparatus to expand the ciliar body effectuating mechanical accommodation. An optical coherence tomographer was used to measure positional and geometrical changes of the IOL for different levels of expansion. The expansion unit allowed stretching of the globe of several millimeters. With the biomechanical eye model we were able to simulate the mechanical functionality of accommodation as well as to measure the lens vault and change in geometry. Accommodative vault could only be measured with an intact vitreous, indicating that the vitreous plays an important role for the functionality of accommodative IOLs.
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Affiliation(s)
- Timo Eppig
- Experimental Ophthalmology, Saarland University, Kirrberger Straße 100, Bldg. 22, 66421 Homburg, Germany.
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Beiko GH. Comparison of visual results with accommodating intraocular lenses versus mini-monovision with a monofocal intraocular lens. J Cataract Refract Surg 2013; 39:48-55. [DOI: 10.1016/j.jcrs.2012.08.059] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 07/31/2012] [Accepted: 08/10/2012] [Indexed: 11/16/2022]
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A randomized intraindividual comparison of the accommodative performance of the bag-in-the-lens intraocular lens in presbyopic eyes. Am J Ophthalmol 2010; 150:619-627.e1. [PMID: 20719298 DOI: 10.1016/j.ajo.2010.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 05/28/2010] [Accepted: 06/02/2010] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare the accommodative performance of the Morcher BioComFold Type 89A bag-in-the-lens intraocular lens (IOL) with a conventional in-the-bag control IOL in presbyopic eyes. DESIGN Prospective, randomized clinical trial with intraindividual comparison. METHODS SETTING Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. STUDY POPULATION Fifty-two eyes of 26 patients with bilateral age-related cataracts. INTERVENTION Phacoemulsification cataract extraction with implantation of a bag-in-the-Lens and a control IOL, the Alcon AcrySof SA60AT (Alcon Laboratories, Fort Worth, Texas, USA), randomized to either eye. MAIN OUTCOME MEASURES Axial IOL shift stimulated by physiologic (near visual effort) and pharmacologic (pilocarpine and cyclopentolate) accommodative stimulation was measured objectively with partial coherence interferometry. Other outcome measures were objective and subjective accommodation, logarithm of the minimal angle of resolution distance-corrected near visual acuity, and defocus curves. RESULTS Three months after surgery, axial IOL shift stimulated by near visual effort measured -5.9 ± 10.3 μm in bag-in-the-lens eyes versus -8.4 ± 12.8 μm in control eyes (P = .37), that stimulated by pilocarpine measured 20.2 ± 165.6 μm versus 50.4 ± 164.4 μm (P = .36), and that stimulated by cyclopentolate measured -65.8 ± 64.3 μm versus -54.0 ± 37.5 μm (P = .34), respectively (n = 25). Objective accommodation measured 0.03 ± 0.18 diopters (D) in bag-in-the-lens eyes versus 0.08 ± 0.21 D in control eyes (P = .40), whereas subjective accommodation measured 2.48 ± 0.72 D versus 2.45 ± 0.80 D (P = .75), respectively. Distance-corrected near visual acuity and defocus curves showed no difference between IOLs. CONCLUSIONS The bag-in-the-lens IOL demonstrated negligible axial shift and objective accommodation with physiologic near visual stimulation. The IOL shift demonstrated with pilocarpine also was clinically insignificant. The bag-in-the-lens IOL showed no accommodative or near visual advantage over a conventional in-the-bag IOL, despite its unique capsular fixation method. This provides further evidence that the focus-shift principle fails to produce clinically significant IOL movement.
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