title: Functional assessment of accommodating intraocular lenses versus monofocal intraocular lenses in cataract surgery: metaanalysis.
abstract: OBJECTIVE
  To compare accommodating intraocular lens (IOLs) and monofocal IOLs in restoring accommodation in cataract surgery.
  
  
  METHODS
  Dartmouth Medical School and Department of Ophthalmology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
  
  
  METHODS
  In this metaanalysis, 2 researchers independently extracted data, assessed trial quality, and contacted authors for missing information. Because of measurement-scale variations, outcomes were pooled for distance-corrected near visual acuity (DCNVA) as standardized mean differences with 95% confidence intervals [CIs] and anterior displacement of the lens as weighted mean differences (95% CI).
  
  
  RESULTS
  The metaanalysis comprised 12 randomized controlled studies of 727 eyes. Based on 10 studies that compared DCNVA, accommodating IOLs were favored but failed the test of heterogeneity (I(2) = 94%). Pooling the 6 homogeneous trials (I(2) = 43%) showed no difference (standardized mean difference, -0.16; 95% CI, -0.56 to 0.25). Heterogeneity could not be explained by any characteristic of the study population or methodology. Based on 4 studies that evaluated pilocarpine-induced IOL shift, there was a significant anterior compared with the control (weighted mean difference, 95% CI, -0.36 - 0.47 to -0.24]), although the studies were heterogeneous (I(2) = 58%). Three of 5 studies mentioning posterior capsule opacification (PCO) reported increased rates in the accommodating IOL group postoperatively.
  
  
  CONCLUSIONS
  There was no clear evidence of near acuity improvement despite statistically significant pilocarpine-induced anterior lens displacement. Further randomized controlled studies with standardized methods evaluating adverse effects (eg, PCO) are needed to clarify the tradeoffs.
authors.affiliation: Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. ako.takakura@dartmouth.edu
authors.forename: Ako
authors.initials: A
authors.lastname: Takakura
authors.forename: Prashanth
authors.initials: P
authors.lastname: Iyer
authors.forename: Jared R
authors.initials: JR
authors.lastname: Adams
authors.forename: Susan M
authors.initials: SM
authors.lastname: Pepin
mesh_terms: D000065:Accommodation, Ocular / Q000502:physiology*; D000368:Aged; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D019591:Pseudophakia / Q000503:physiopathology*; D016032:Randomized Controlled Trials as Topic; D014792:Visual Acuity / Q000502:physiology*