Measurement of accommodation after implantation of an accommodating posterior chamber intraocular lens.
OBJECTIVE
To analyze techniques of measuring accommodation after implantation of an accommodating posterior chamber intraocular lens (PC IOL).


METHODS
Department of Ophthalmology and University Eye Hospital, University Erlangen-Nürnberg, Erlangen, Germany.


METHODS
This prospective study analyzed 23 eyes of 23 patients (aged 41 to 87 years) after cataract surgery and PC IOL implantation (1 CU, HumanOptics) 4 weeks and 3 and 6 months after surgery. The results were compared to those in an age-matched control group (n = 20) 6 months after surgery. The following methods were used to measure accommodation: dynamic with objective techniques (PlusOptix PowerRefractor videorefractometry, streak retinoscopy) and subjective techniques (subjective near point [push-up test, accommodometer], defocusing); static with pharmacologic stimulation after pilocarpine 2% eyedrops directly (conventional refractometry); indirectly (change in the anterior chamber depth [ACD] with Zeiss IOLMaster).


RESULTS
Results at 6 months, given as mean +/- SD (range), in the study and control groups, respectively, were as follows: near visual acuity (Birkhäuser reading charts at 35 cm) with distance correction, 0.32 +/- 0.11 (0.20 to 0.60) and 0.14 +/- 0.10 (0.05 to 0.30); accommodation amplitude (diopters) by PowerRefractor, 1.00 +/- 0.44 (0.75 to 2.13) and 0.35 +/- 0.26 (0.10 to 0.65), by retinoscopy, 0.99 +/- 0.48 (0.13 to 2.00) and 0.24 +/- 0.21 (-0.13 to +0.75), by subjective near point, 1.60 +/- 0.55 (0.50 to 2.56) and 0.42 +/- 0.25 (0.00 to 0.75), and by defocusing, 1.46 +/- 0.53 (1.00 to -2.50) and 0.55 +/- 0.33 (0.25 to 0.87). The mean ACD decrease (mm) was 0.78 +/- 0.12 (0.49 to 1.91) and 0.16 +/- 0.09 (0.00 to 0.34) after pilocarpine 2% eyedrops, indicating a mean accommodation of 1.40 D and 0.29 D, respectively, based on Gullstrand's model eye (P =.001). The lowest fluctuation between follow-ups was with the subjective near point and the defocusing techniques followed by ACD decrease with the IOLMaster.


CONCLUSIONS
Accommodation after implantation of an accommodating PC IOL should be assessed with several techniques, including subjective and objective, to differentiate true pseudophakic accommodation from pseudoaccommodation. Researchers should be aware of the different variability and consistency of measurements with each technique over time.
Langenbucher
Achim
A
Department of Ophthalmology and University Eye Hospital, University Erlangen-Nürnberg, Germany. achim.langenbucher@augen.imed.unierlangen.de
Huber
Stefan
S
Nguyen
Nhung X
NX
Seitz
Berthold
B
Gusek-Schneider
Gabriele C
GC
Küchle
Michael
M
D000065:Accommodation, Ocular / Q000502:physiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000187:drug effects; D019923:Capsulorhexis; D003941:Diagnostic Techniques, Ophthalmological; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D008916:Miotics / Q000494:pharmacology; D018918:Phacoemulsification; D010862:Pilocarpine / Q000494:pharmacology; D011446:Prospective Studies; D019591:Pseudophakia / Q000503:physiopathology*
D008916:Miotics; D010862:Pilocarpine