title: Pseudo-accommodation in non-amblyopic children after bilateral cataract surgery and implantation with a monofocal intraocular lens: prevalence and possible mechanisms.
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.
authors: Fondation Rothschild, 25 rue Manin, 75019, Paris, France. charlotte.denier@aphp.fr.
authors: Charlotte
authors: http://orcid.org/0000-0003-0461-3472
authors: C
authors: Dénier
authors: Fondation Rothschild, 25 rue Manin, 75019, Paris, France.
authors: Pascal
authors: P
authors: Dureau
authors: Fondation Rothschild, 25 rue Manin, 75019, Paris, France.
authors: Catherine
authors: C
authors: Edelson
authors: Fondation Rothschild, 25 rue Manin, 75019, Paris, France.
authors: Amandine
authors: A
authors: Barjol
authors: Fondation Rothschild, 25 rue Manin, 75019, Paris, France.
authors: Georges
authors: G
authors: Caputo
mesh_terms: D000065:Accommodation, Ocular / Q000502:physiology*; D000368:Aged; D000550:Amblyopia; D002387:Cataract Extraction; D002648:Child; D002675:Child, Preschool; D003315:Cornea / Q000473:pathology*; D019781:Corneal Topography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007910:Lenses, Intraocular; D008297:Male; D011474:Prosthesis Design; D019591:Pseudophakia / Q000175:diagnosis / Q000503:physiopathology*; D012029:Refraction, Ocular / Q000502:physiology*; D012189:Retrospective Studies; D013997:Time Factors; D014787:Vision Tests; D014792:Visual Acuity / Q000502:physiology*
keywords: Aberrometry; Monofocal IOL; Multifocality; Pediatric cataract; Pseudo-accommodation