open access

Vol 3, No 2 (2018)
Original paper
Published online: 2018-11-29
Get Citation

Subjective and objective accommodation of the Crystalens Advanced Optics (AO) in patients 6 months after bilateral implantation

Marcus Walckling1, Ria Beck1, Oliver Stachs1, Rudolf F. Guthoff1
·
Ophthalmol J 2018;3(2):29-36.
Affiliations
  1. Department of Ophthalmology, University of Rostock, Rostock, Germany

open access

Vol 3, No 2 (2018)
ORIGINAL PAPERS
Published online: 2018-11-29

Abstract

Background: The aim of this study was to analyze and compare objective and subjective accommodation in patients after bilateral implantation of the FDA-approved accommodating Crystalens Advanced Optics (AO). Material and methods: This study was performed on 8 eyes of 4 patients. The subjective accommodation was measured by monocular and binocular defocus curves under photopic and mesopic conditions. The objective accommodation was analyzed using partial coherence interferometry (PCI) and wavefront aberration. Pupil diameter at different set-ups and refraction were derived from wavefront data. Results: Uncorrected and corrected distance and uncorrected near visual acuity improved significantly following implantation of the Crystalens AO in all eyes. Only one patient needed spectacles to correct distance visual acuity. Mean distance uncorrected visual acuity was 0.05 ± 0.06 logMAR. All patients were able to read newspapers without spectacles. Mean near uncorrected visual acuity was 0.17 ± 0.12 logMAR. Subjective accommodative amplitude under photopic conditions was significantly better binocularly than monocularly (p = 0.03) and was significant worse monocularly under mesopic conditions than photopic conditions (p = 0.016). No significant changes in anterior chamber depth were observed by PCI, with a fixation on optical stimuli at different distances. There were also no significant changes in the wavefront aberrations between the different set-ups. Pupil diameter increased significantly in the near set-up under mesopic conditions. Conclusions: No objective change in lens configuration was observed under different set-ups. Due to a variety of factors involved in pseudoaccommodation (e.g. pupil diameter, astigmatism, and multifocality), the subjective accommodative amplitude tends to be overestimated relative to objective measurements. No real accommodative action was observed.

Abstract

Background: The aim of this study was to analyze and compare objective and subjective accommodation in patients after bilateral implantation of the FDA-approved accommodating Crystalens Advanced Optics (AO). Material and methods: This study was performed on 8 eyes of 4 patients. The subjective accommodation was measured by monocular and binocular defocus curves under photopic and mesopic conditions. The objective accommodation was analyzed using partial coherence interferometry (PCI) and wavefront aberration. Pupil diameter at different set-ups and refraction were derived from wavefront data. Results: Uncorrected and corrected distance and uncorrected near visual acuity improved significantly following implantation of the Crystalens AO in all eyes. Only one patient needed spectacles to correct distance visual acuity. Mean distance uncorrected visual acuity was 0.05 ± 0.06 logMAR. All patients were able to read newspapers without spectacles. Mean near uncorrected visual acuity was 0.17 ± 0.12 logMAR. Subjective accommodative amplitude under photopic conditions was significantly better binocularly than monocularly (p = 0.03) and was significant worse monocularly under mesopic conditions than photopic conditions (p = 0.016). No significant changes in anterior chamber depth were observed by PCI, with a fixation on optical stimuli at different distances. There were also no significant changes in the wavefront aberrations between the different set-ups. Pupil diameter increased significantly in the near set-up under mesopic conditions. Conclusions: No objective change in lens configuration was observed under different set-ups. Due to a variety of factors involved in pseudoaccommodation (e.g. pupil diameter, astigmatism, and multifocality), the subjective accommodative amplitude tends to be overestimated relative to objective measurements. No real accommodative action was observed.

Get Citation

Keywords

accommodation; Crystalens; presbyopia correction

About this article
Title

Subjective and objective accommodation of the Crystalens Advanced Optics (AO) in patients 6 months after bilateral implantation

Journal

Ophthalmology Journal

Issue

Vol 3, No 2 (2018)

Article type

Original paper

Pages

29-36

Published online

2018-11-29

Page views

740

Article views/downloads

1119

DOI

10.5603/OJ.2018.0034

Bibliographic record

Ophthalmol J 2018;3(2):29-36.

Keywords

accommodation
Crystalens
presbyopia correction

Authors

Marcus Walckling
Ria Beck
Oliver Stachs
Rudolf F. Guthoff

References (21)
  1. Duane A. Normal values of the accommodation at all ages. JAMA. 1912; 59(12): 1010–1013.
  2. Winther-Nielsen A, Gyldenkerne G, Corydon L. Contrast sensitivity, glare, and visual function: diffractive multifocal versus bilateral monofocal intraocular lenses. J Cataract Refract Surg. 1995; 21(2): 202–207.
  3. Haaskjold E, Allen ED, Burton RL. Contrast sensitivity after implantation of diffractive bifocal and monofocal intraocular lenses. J Cataract Refract Surg. 1998; 24(5): 653–658.
  4. Bacskulin A, Martin H, Kundt G, et al. [Analysis of the dynamics of the ciliary muscle during accommodation]. Ophthalmologe. 2000; 97(12): 855–859.
  5. Findl O, Kiss B, Petternel V, et al. Intraocular lens movement caused by ciliary muscle contraction. J Cataract Refract Surg. 2003; 29(4): 669–676.
  6. Langenbucher A, Seitz B, Huber S, et al. Theoretical and measured pseudophakic accommodation after implantation of a new accommodative posterior chamber intraocular lens. Arch Ophthalmol. 2003; 121(12): 1722–1727.
  7. Cleary G, Spalton DJ, Marshall J. Pilot study of new focus-shift accommodating intraocular lens. J Cataract Refract Surg. 2010; 36(5): 762–770.
  8. Findl O, Drexler W, Menapace R, et al. High precision biometry of pseudophakic eyes using partial coherence interferometry. J Cataract Refract Surg. 1998; 24(8): 1087–1093.
  9. Gupta N, Naroo SA, Wolffsohn JS. Is randomisation necessary for measuring defocus curves in pre-presbyopes? Cont Lens Anterior Eye. 2007; 30(2): 119–124.
  10. Häring G, Dick H, Krummenauer F, et al. Subjective photic phenomena with refractive multifocal and monofocal intraocular lenses. J Cataract Refract Surg. 2001; 27(2): 245–249.
  11. Hayashi K, Yoshida M, Manabe SI, et al. Optimal amount of anisometropia for pseudophakic monovision. J Refract Surg. 2011; 27(5): 332–338.
  12. Wittpenn JJ. Mini-monovision with the Tecnis 1-Piece provides better-than-expected near vision with minimal compromise at distance. Cataract Refract Surg Today. 2010: 70.
  13. Koeppl C, Findl O, Menapace R, et al. Pilocarpine-induced shift of an accommodating intraocular lens: AT-45 Crystalens. J Cataract Refract Surg. 2005; 31(7): 1290–1297.
  14. Kriechbaum K, Findl O, Koeppl C, et al. Stimulus-driven versus pilocarpine-induced biometric changes in pseudophakic eyes. Ophthalmology. 2005; 112(3): 453–459.
  15. Coleman DJ. Unified model for accommodative mechanism. Am J Ophthalmol. 1970; 69(6): 1063–1079.
  16. Ossma IL, Galvis A, Vargas LG, et al. Synchrony dual-optic accommodating intraocular lens. Part 2: pilot clinical evaluation. J Cataract Refract Surg. 2007; 33(1): 47–52.
  17. Win-Hall DM, Glasser A. Objective accommodation measurements in pseudophakic subjects using an autorefractor and an aberrometer. J Cataract Refract Surg. 2009; 35(2): 282–290.
  18. Oshika T, Mimura T, Tanaka S. Apparent accommodation and corneal wavefront aberration in pseudophakic eyes. Invest Ophthalmol Vis Sci. 2002; 43(9): 2882–2886 .
  19. Trindade F, Oliveira A, Frasson M. Benefit of against-the-rule astigmatism to uncorrected near acuity. J Cataract Refract Surg. 1997; 23(1): 82–85.
  20. Form and Function: The Crystalens HD. DataLink statistics and clinical experience from the San Francisco users’ meeting. Cataract Refract Surg Today. 2009; Suppl: 1–16.
  21. Alió JL, Piñero DP, Plaza-Puche AB. Visual outcomes and optical performance with a monofocal intraocular lens and a new-generation single-optic accommodating intraocular lens. J Cataract Refract Surg. 2010; 36(10): 1656–1664.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Publisher: VM Media Group sp. z o.o., Grupa Via Medica, 73 Świętokrzyska St., 80–180 Gdańsk

tel.:+48 58 310 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl