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Schallhorn JM, Pantanelli SM, Lin CC, Al-Mohtaseb ZN, Steigleman WA, Santhiago MR, Olsen TW, Kim SJ, Waite AM, Rose-Nussbaumer JR. Multifocal and Accommodating Intraocular Lenses for the Treatment of Presbyopia: A Report by the American Academy of Ophthalmology. Ophthalmology 2021; 128:1469-1482. [PMID: 33741376 DOI: 10.1016/j.ophtha.2021.03.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To review the published literature assessing the efficacy and safety of presbyopia-correcting intraocular lenses (IOLs) for the treatment of presbyopia after cataract removal. METHODS Literature searches were undertaken in January 2018 and September 2020 in the PubMed, Medline, and Cochrane Library databases. This yielded 761 articles, of which 34 met the criteria for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. Thirteen studies were rated level I and 21 studies were rated level II. RESULTS Presbyopia-correcting lenses were effective at improving distance and near visual acuity after cataract surgery. Near acuity at different focal lengths was related directly to the effective add power of multifocal and extended depth-of-focus (EDOF) IOLs. Most multifocal and EDOF lenses that were compared with a control monofocal lens demonstrated that patient-reported spectacle independence was superior to the monofocal lens. All patients who had multifocal and EDOF lenses implanted showed decreased contrast sensitivity and reported more visual phenomena as compared with control participants who received monofocal lenses. CONCLUSIONS Presbyopia-correcting lenses improve uncorrected near and distance visual acuity and decrease spectacle dependence after cataract surgery. Mesopic contrast sensitivity is decreased compared with monofocal lenses, and patient-reported visual phenomena are more likely in patients receiving multifocal or EDOF lenses.
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Affiliation(s)
- Julie M Schallhorn
- Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, California
| | - Seth M Pantanelli
- Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Charles C Lin
- Byers Eye Institute, Stanford University, Palo Alto, California
| | | | | | | | - Timothy W Olsen
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Stephen J Kim
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Jennifer R Rose-Nussbaumer
- Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, California; Division of Research, Kaiser Permanente Northern California, Oakland, California
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Kaweri L, Wavikar C, James E, Pandit P, Bhuta N. Review of current status of refractive lens exchange and role of dysfunctional lens index as its new indication. Indian J Ophthalmol 2020; 68:2797-2803. [PMID: 33229654 PMCID: PMC7856935 DOI: 10.4103/ijo.ijo_2259_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Advances in phacodynamics and intraocular lenses (IOLs) has given second life to clear lens extraction (CLE) or refractive lens exchange (RLE) in recent years for the treatment of patients with high degrees of myopia, hyperopia, and astigmatism who are unsuitable for laser surgery. Furthermore, presbyopia treatment with RLE supplemented with multifocal or accommodating IOLs gives the dual benefit of correcting refractive errors with eliminating the need for cataract surgery. RLE should be consistent and effective for a good refractive outcome along with safety during the surgical procedure and in the postoperative period. Therefore, proper patient selection and accurate preoperative protocols for IOL power calculations and selection are important along with an appropriate choice of surgical procedure. Dysfunctional lens index is a new objective tool that helps surgeon to aid in diagnosing, counseling, and educating patients with dysfunctional clear lens. In this article, we give a brief overview about the application of RLE for individuals with presbyopia and refractive errors like myopia, hyperopia, and astigmatism who are not suitable for laser correction.
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Affiliation(s)
- Luci Kaweri
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Chandrashekhar Wavikar
- Department of Cataract and Refractive Surgery, Wavikar Eye Institute, Mumbai, Maharashtra, India
| | - Edwin James
- Assistant Professor, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Payal Pandit
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Namrata Bhuta
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
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Bilbao-Calabuig R, Gónzalez-López F, Llovet-Rausell A, Ortega-Usobiaga J, Tejerina Fernández V, Llovet-Osuna F. Lens-based surgical correction of presbyopia. Where are we in 2020? ACTA ACUST UNITED AC 2020; 96:74-88. [PMID: 32868085 DOI: 10.1016/j.oftal.2020.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Presbyopia is the progressive and irreversible loss of accommodation due to aging. It is one of the main causes of loss of quality of life in people from 45 years of age, due to the, often novel, dependence on spectacles. The eagerness to correct it by ophthalmologists impulsed by the desire of millions of people who suffer from it, has become one of the main drivers for the development of intraocular lens (IOL) technology over the last twenty years. MATERIAL AND METHODS This review briefly presents the different alternatives that have allowed us to improve the crystalline lens surgical approach of presbyopia; from monofocal lenses and monovision technique, accommodative, refractive, and diffractive multifocal lenses, and finally the most recent extended depth of focus/field lenses known as EDOFs. RESULTS Each IOL has its advantages, limitations and disadvantages. Furthermore, there is no single lens that suits the needs of all patients. CONCLUSIONS It is necessary to know the variety of lenses available, and to have an in-depth understanding of their optical properties, as well as the impact that these will have later on their clinical performance and on the visual quality of the patients. This should help us to select the best alternative for each of them.
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Affiliation(s)
- R Bilbao-Calabuig
- Unidad de Cirugía Refractiva y Cataratas, Clínica Baviera-Aier Hospital Eye Group, Madrid, España.
| | - F Gónzalez-López
- Unidad de Cirugía Refractiva y Cataratas, Clínica Baviera-Aier Hospital Eye Group, Madrid, España
| | - A Llovet-Rausell
- Unidad de Cirugía Refractiva y Cataratas, Clínica Baviera-Aier Hospital Eye Group, Valencia, España; Servicio Oftalmología, Hospital Universitario La Fe, Valencia, España
| | - J Ortega-Usobiaga
- Unidad de Cirugía Refractiva y Cataratas, Clínica Baviera-Aier Hospital Eye Group, Bilbao, España
| | - V Tejerina Fernández
- Unidad de Cirugía Refractiva y Cataratas, Clínica Baviera-Aier Hospital Eye Group, Madrid, España
| | - F Llovet-Osuna
- Unidad de Cirugía Refractiva y Cataratas, Clínica Baviera-Aier Hospital Eye Group, Madrid, España; Unidad de Cirugía Refractiva y Cataratas, Clínica Baviera-Aier Hospital Eye Group, Valencia, España
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Small aperture IC-8 intraocular lens in cataract patients: achieving extended depth of focus through small aperture optics. Eye (Lond) 2019; 33:1096-1103. [PMID: 30792521 DOI: 10.1038/s41433-019-0363-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/29/2018] [Accepted: 01/13/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To investigate visual outcomes following cataract surgery in patients who were implanted monocularly with an extended range of focus IC-8 IOL. METHODS A multicentre, non-randomised, retrospective case series of 126 consecutive patients implanted with the IC-8 IOL. Data were collected and pooled from six centres across Australia. Uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 80 cm and uncorrected near visual acuity (UNVA) at 40 cm were measured in eyes implanted with the IC-8 IOL. Adverse events, spectacle independence, visual symptoms and patient satisfaction were assessed at final follow-up. RESULTS Over 90% of the patients without pre-existing ocular pathology (n = 109) achieved UDVA, UIVA and UNVA of 6/12 or better in the IC-8 eye. Binocularly, in this group, 98% achieved UDVA of 6/9, 94% UIVA of 6/12 and 91% UNVA of 6/12 or better. By final follow-up, over 50% of patients reported complete spectacle independence for distance, intermediate and near visual activity, with the remainder only using spectacles for specific tasks such as near-vision hobbies and reading in dim light. CONCLUSIONS The IC-8 IOL is capable of providing extended depth of focus following cataract surgery. It allows complete spectacle independence in more than half of the patients implanted with the IC-8 IOL.
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Davidson RS, Dhaliwal D, Hamilton DR, Jackson M, Patterson L, Stonecipher K, Yoo SH, Braga-Mele R, Donaldson K. Surgical correction of presbyopia. J Cataract Refract Surg 2018; 42:920-30. [PMID: 27373400 DOI: 10.1016/j.jcrs.2016.05.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 01/23/2016] [Accepted: 01/26/2016] [Indexed: 01/02/2023]
Abstract
UNLABELLED Presbyopia is the most common refractive disorder for people older than 40 years. It is characterized by a gradual and progressive decrease in accommodative amplitude. Many surgical procedures for the correction of presbyopia exist, with additional procedures on the horizon. This review describes the prevalent theories of presbyopia and discusses the available surgical options for correction. FINANCIAL DISCLOSURE Proprietary or commercial disclosures are listed after the references.
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Affiliation(s)
- Richard S Davidson
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA.
| | - Deepinder Dhaliwal
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - D Rex Hamilton
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Mitchell Jackson
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Larry Patterson
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Karl Stonecipher
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sonia H Yoo
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rosa Braga-Mele
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kendall Donaldson
- University of Colorado Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
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Zhou H, Zhu C, Xu W, Zhou F. The efficacy of accommodative versus monofocal intraocular lenses for cataract patients: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e12693. [PMID: 30290663 PMCID: PMC6200466 DOI: 10.1097/md.0000000000012693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION We performed a systematic review and meta-analysis to evaluate whether accommodative intraocular lenses (AC-IOLs) are superior for cataract patients compared with monofocal IOLs (MF-IOLs). METHODS Pubmed, Embase, Cochrane library, CNKI, and Wanfang databases were searched through in August 2018 for AC-IOLs versus MF-IOLs in cataract patients. Studies were pooled under either fixed-effects model or random-effects model to calculate the relative risk (RR), weighted mean difference (WMD), or standard mean difference (SMD) and their corresponding 95% confidence interval (CI). Distance-corrected near visual acuity (DCNVA) was chosen as the primary outcome. The secondary outcomes were corrected distant visual acuity (CDVA), pilocarpine-induced IOL shift, contrast sensitivity, and spectacle independence. RESULTS Seventeen studies, involving a total of 1764 eyes, were included. Our results revealed that AC-IOLs improved DCNVA (SMD = -1.84, 95% CI = -2.56 to -1.11) and were associated with significantly greater anterior lens shift than MF-IOLs (WMD = -0.30, 95% CI = -0.37 to -0.23). Furthermore, spectacle independence was significantly better with AC-IOLs than with MF-IOLs (RR = 3.07, 95% CI = 1.06-8.89). However, there was no significant difference in CDVA and contrast sensitivity between the 2 groups. CONCLUSION Our study confirmed that AC-IOLs can provide cataract patients with DCNVA and result in more high levels of spectacle independence than MF-IOLs. Further studies with larger data set and well-designed models are required to validate our findings.
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Affiliation(s)
- Hongwei Zhou
- Department of Ophthalmology, Lianshui County People's Hospital, Lianshui, Huai'an
- Department of Diabetes, School of Medicine, Southeast University, Nanjing
| | - Chongyan Zhu
- Department of Ophthalmology, Lianshui County People's Hospital, Lianshui, Huai'an
| | - Wenya Xu
- Department of Ophthalmology, Lianshui County People's Hospital, Lianshui, Huai'an
| | - Fang Zhou
- Beijing Key Laboratory of Megaregions Sustainable Development Modeling, Capital University of Economics and Business, Beijing, China
- Department of Statistics, Stockholm University, Stockholm, Sweden
- College of Urban Economics and Public Administration, Capital University of Economics and Business, Beijing, China
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Liang YL, Jia SB. Clinical application of accommodating intraocular lens. Int J Ophthalmol 2018; 11:1028-1037. [PMID: 29977819 DOI: 10.18240/ijo.2018.06.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 12/18/2017] [Indexed: 12/28/2022] Open
Abstract
The present review describes recent advances in application of accommodating intraocular lenses (AIOLs). Standard monofocal intraocular lenses (MIOLs) only correct distance vision, while AIOLs are designed to allow both good distance vision and near vision, which is achieved through the contraction and relaxation of ciliary muscles by providing transformation of the axial movement or curvature of the lens. Thus, AIOLs may be a better choice for those patients who demand a higher level of visual performance. Since techniques to analyze the performance of AIOLs have not been standardized, and there is a variety of both subjective and objective methods, it is hard to measure the performance of these intraocular lenses. By evaluating advantages and disadvantages of various AIOLs, and introducing techniques for measurement the performance postoperative, this paper can provide some relative information on choosing the type of AIOLs in the clinic.
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Affiliation(s)
- You-Ling Liang
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Song-Bai Jia
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
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Alió JL, Alió Del Barrio JL, Vega-Estrada A. Accommodative intraocular lenses: where are we and where we are going. EYE AND VISION 2017; 4:16. [PMID: 28674696 PMCID: PMC5485553 DOI: 10.1186/s40662-017-0077-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 04/19/2017] [Indexed: 11/12/2022]
Abstract
Presbyopia still remains the last frontier of refractive surgery. Its surgical management is under constant evolution due to the limitations that exist today with respect to its management, which is probably in relation with the multifactorial basis in which presbyopia is clinically developed in the human. Until currently, virtually all surgical techniques that have been proposed for its correction are based on the induction of pseudoaccommodation in the presbyopic eye, including multifocality. However, the real restoration of accommodation is more complex, and it has been tried by the use of different, so called, “accommodative” pseudophakic intraocular lenses (AIOL). Overall, the reported results with these lenses by independent authors have been modest in relation with the restoration of the accommodative power of the eye and these modest benefits are usually lost with time due to the long term changes in the capsular bag. This fact made these lenses to be almost abandoned in the last few years, but there are currently other AIOL models being used with innovative mechanisms of action and different anatomical support outside the capsular bag that offer encouraging preliminary results that could bring a new potential of application to these types of lenses. In this article, we will update the modern refractive surgeon about the fundamentals and provide updated information about the outcomes of AIOLs by reviewing the concept of accommodation, the different attempts that have been accomplished in the past, their demonstrated published results in human clinical trials, and the future alternatives that may arrive in the near future.
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Affiliation(s)
- Jorge L Alió
- Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Avda de Denia s/n, Edificio Vissum, 03016 Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Jorge L Alió Del Barrio
- Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Avda de Denia s/n, Edificio Vissum, 03016 Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Alfredo Vega-Estrada
- Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Avda de Denia s/n, Edificio Vissum, 03016 Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
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Hipsley A, Ma DHK, Sun CC, Jackson MA, Goldberg D, Hall B. Visual outcomes 24 months after LaserACE. EYE AND VISION 2017; 4:15. [PMID: 28812042 PMCID: PMC5473977 DOI: 10.1186/s40662-017-0081-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/01/2017] [Indexed: 12/04/2022]
Abstract
Background To evaluate the effects on near and intermediate visual performance after bilateral Laser Anterior Ciliary Excision (LaserACE) procedure. Methods LaserACE surgery was performed using the VisioLite 2.94 μm erbium: yttrium–aluminum–garnet (Er:YAG) ophthalmic laser system in 4 oblique quadrants on the sclera over the ciliary muscle in 3 critical zones of physiological importance (over the ciliary muscles and posterior zonules) with the aim to improve natural dynamic accommodative forces. LaserACE was performed on 26 patients (52 eyes). Outcomes were analyzed using visual acuity testing, Randot stereopsis, and the CatQuest 9SF patient survey. Results Binocular uncorrected near visual acuity (UNVA) improved from +0.20 ± 0.16 logMAR preoperatively, to +0.12 ± 0.14 logMAR at 24 months postoperatively (p = 0.0014). There was no statistically significant loss in distance corrected near visual acuity (DCNVA). Binocular DCNVA improved from +0.21 ± 0.17 logMAR preoperatively, to +0.11 ± 0.12 logMAR at 24 months postoperatively (p = 0.00026). Stereoacuity improved from 74.8 ± 30.3 s of arc preoperatively, to 58.8 ± 22.9 s of arc at 24 months postoperatively (p = 0.012). There were no complications such as persistent hypotony, cystoid macular edema, or loss of best-corrected visual acuity (BCVA). Patients surveyed indicated reduced difficulty in areas of near vision, and were overall satisfied with the procedure. Conclusions Preliminary results of the LaserACE procedure show promising results for restoring visual performance for near and intermediate visual tasks without compromising distance vision and without touching the visual axis. The visual function and visual acuity improvements had clinical significance. Patient satisfaction was high postoperatively and sustained over 24 months. Trial registration NCT01491360 (https://clinicaltrials.gov/ct2/show/NCT01491360). Registered 22 November 2011.
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Affiliation(s)
| | - David Hui-Kang Ma
- Department of Ophthalmology, Chang Gung Memorial Hospital, Kweishan, Taoyuan Taiwan.,Department of Chinese Medicine, Chang Gung University, Kweishan, Taoyuan Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Kweishan, Taoyuan Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Kweishan, Taoyuan Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Mitchell A Jackson
- Ace Vision Group Inc, 39655 Eureka Drive, Newark, CA 94560 USA.,Jackson Eye, Lake Villa, IL USA
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Sequential intrastromal corneal ring segment and monofocal intraocular lens implantation for keratoconus and cataract: Long-term follow-up. J Cataract Refract Surg 2017; 43:246-254. [DOI: 10.1016/j.jcrs.2016.11.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 11/24/2022]
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Pseudo-accommodation in non-amblyopic children after bilateral cataract surgery and implantation with a monofocal intraocular lens: prevalence and possible mechanisms. Graefes Arch Clin Exp Ophthalmol 2016; 255:407-412. [PMID: 27785598 DOI: 10.1007/s00417-016-3526-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/25/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Some pseudophakic patients implanted with a monofocal intraocular lens (IOL) have good near visual acuity (VA) with their distance correction. The objective was to evaluate the prevalence of pseudo-accommodation in children after bilateral cataract surgery, without amblyopia, and to define its mechanisms. METHODS Observational study that took place in a pediatric ophthalmology department, Paris, France. A total of 68 eyes were included, 40 from 23 children and 28 from 14 adults, with a corrected distance VA above 20/25 and a normal near VA (20/25) with +3 addition. Pseudo-accommodation was defined as a near VA better than 20/50 with the distance correction and without addition. Prevalence of pseudo-accommodation was calculated in each group. In order to determine the possible mechanisms of pseudo-accommodation in children, we compared children with pseudo-accommodation and adults without pseudo-accommodation regarding several parameters: refraction, axial length, corneal topography, aberrometry, pupillary diameter and IOL shift after cyclopentolate instillation. RESULTS Among the children group, 36 (90 %) had pseudo-accommodation versus 2 (7 %) in the adult group. We found that spherical equivalent, implant power, corneal multifocality and corneal higher-order aberrations (mainly coma and trefoil) were significantly higher in the pseudo-accommodation group, while pupil diameter and implant shift were not significantly different. CONCLUSIONS Pseudo-accommodation has a high prevalence among non-amblyopic pseudophakic children. Several possible mechanisms have been found to explain pseudo-accommodation in children: a high power of the IOL and a small axial length, maximizing the effect of the IOL shift, corneal multifocality and corneal higher-order aberrations.
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Alio JL, Simonov A, Plaza-Puche AB, Angelov A, Angelov Y, van Lawick W, Rombach M. Visual Outcomes and Accommodative Response of the Lumina Accommodative Intraocular Lens. Am J Ophthalmol 2016; 164:37-48. [PMID: 26829595 DOI: 10.1016/j.ajo.2016.01.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/08/2016] [Accepted: 01/23/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare visual acuity, accommodation, and contrast sensitivity of the AkkoLens Lumina accommodative intraocular lens (AkkoLens Clinical b.v., Breda, The Netherlands) with a standard monofocal intraocular lens (IOL). DESIGN Randomized clinical trial. METHODS The study enrolled 86 eyes with cataract that all required cataract surgery and IOL implantation. The study group included 61 eyes that were implanted with the Lumina. The control group included 25 eyes that were implanted with an Acrysof SA60AT (Alcon, Fort Worth, TX, USA) monofocal IOL. The distance and near visual acuities, contrast sensitivity, and accommodation were measured over a 1-year follow-up period. Accommodation was measured subjectively, using defocus curves, and objectively, with an open-field autorefractor. RESULTS Uncorrected (UDVA) and corrected (CDVA) distance visual acuities did not differ significantly between the groups (P ≥ .21) over the 12 months. However, the uncorrected near visual acuity (UNVA) was 0.07 ± 0.08 logRAD for the Lumina group and 0.37 ± 0.19 logRAD for the control group (P < .01) and the corrected distance near visual acuity (CDNVA) was 0.11 ± 0.12 LogRAD for the Lumina group and 0.41 ± 0.15 LogRAD for the control group (P < .01). Defocus curves showed a statistically significant difference between groups for defocus ranging from -4.50 to -0.50 diopters (D) (P < .01) with significantly higher visual acuities for the Lumina group. Subjective accommodation, as determined from defocus curves, was 3.05 ± 1.06, 3.87 ± 1.27, and 5.59 ± 1.02 D for the Lumina group and 1.46 ± 0.54, 2.00 ± 0.52, and 3.67 ± 0.75 D for the control group at visual acuities of 0.10, 0.20, and 0.4 logMAR for both groups, respectively. The objective accommodation, measured by an open-field autorefractor, was 0.63 ± 0.41, 0.69 ± 0.45, 0.91 ± 0.51, and 1.27 ± 0.76 D for the Lumina group and 0.10 ± 0.15, 0.12 ± 0.15, -0.06 ± 0.09 and 0.07 ± 0.10 D for the control group at accommodation stimuli of 2.0, 2.5, 3.0, and 4.0 D, respectively. Contrast sensitivity was the same for both groups (P ≥ .26). CONCLUSIONS The Lumina accommodative IOL effectively restores the visual function, accommodation, and contrast sensitivity after cataract surgery with no influence on the postoperative contrast sensitivity.
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Tomás-Juan J, Piñero DP, Murueta-Goyena AL. Single-optic positional accommodating intraocular lenses: a review. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2014.947275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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