title: The pupil can control an artificial lens intuitively.
abstract: OBJECTIVE
  After cataract surgery, the ability to accommodate is lost. For this reason, a mechatronic IOL is being developed at the moment: The Artificial Accommodation System. This device requires an easily measureable indicator of the distance of the observed object to determine the demand of accommodation. As the pupil constricts with near vision, pupil size might be such an indicator. Our research focused on whether the pupil can control an artificial lens.
  
  
  METHODS
  A study with 14 healthy subjects aged between 24 and 64 years was conducted. An artificial lens with variable refractive power was mounted in front of one eye. In this eye, natural accommodation was greatly reduced or absent due to presbyopia, pseudophakia, or iatrogenic cycloplegia. The lens' refractive power was changed in a computer-controlled manner depending on changes in the pupil diameter of the second eye, which could not see the fixation stimulus. The subject's task was to get a clear focused image of the target in different distances.
  
  
  RESULTS
  The lens can be controlled by the pupil intuitively (P < 1.8 × 10(-18)). Without prior knowledge, 11/14 subjects passed the first trial, and 31/41 trials were successful. Only one subject was not able to control the lens at all. Most subjects comprehended instantly how to use the unfamiliar lens control to bring a target into focus.
  
  
  CONCLUSIONS
  This study emphasizes the plasticity of the visual control system. Positioning accuracy was acceptable, but the control must be optimized to facilitate maintaining a defined refractive power.
authors.affiliation: Institute of Applied Computer Science, Karlsruhe Institute of Technology, Eggenstein-Leopoldshafen, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Fliedner
authors.forename: Christian
authors.initials: C
authors.lastname: Heine
authors.forename: Georg
authors.initials: G
authors.lastname: Bretthauer
authors.forename: Helmut
authors.initials: H
authors.lastname: Wilhelm
mesh_terms: D000065:Accommodation, Ocular / Q000502:physiology*; D000221:Adaptation, Ocular / Q000502:physiology*; D000328:Adult; D005260:Female; D006801:Humans; D019545:Intuition; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D011680:Pupil / Q000502:physiology*; D012029:Refraction, Ocular / Q000502:physiology; D014785:Vision, Ocular / Q000502:physiology*; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
keywords: IOL; accommodation; neural control; pupil