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Journal of Refractive Surgery, 2010;26(10):772–779
Cite this articlePublished Online:https://doi.org/10.3928/1081597X-20100921-02Cited by:7

Abstract

Purpose:

To investigate objective measures of the effects of accommodative training of a pseudophakic eye implanted with a Crystalens AT-52SE (eyeonics Inc) intraocular lens (IOL) on reading performance, accommodation, and depth of focus.

Methods:

Objective dynamic measures of accommodation, pupil size, and depth of focus were quantified from wavefront measures before and after 1 week of accommodative training that began 29 months after implantation of an accommodating IOL in one patient. Depth of focus was estimated from 50% cut-off of peak performance levels for defocus curves that were computed from the image quality metric VSOTF based on ocular wavefront aberrations.

Results:

The patient reported improved near vision reading performance after completing the training procedure. After training, there was a shift in conjugate focus in the hyperopic direction, yet the depth of focus increased significantly for near objects. Simulated retinal images and the calculated modulation transfer function of the eye both demonstrated improved quality for near vision after training.

Conclusions:

The subjective report of improved near vision after training was correlated with improvement of objective measures. Depth of focus increased for near objects with attempts to accommodate after training. This change was linked to increases in aberrations and pupil size and occurred despite the conjugate focus shifting in the hyperopic direction. These results demonstrate that accommodative training may be useful in improving near vision in patients with accommodating IOLs.

  • 1.CrystaLens™ Model AT-45 Accommodating IOL - P030002. Available at: http://www.fda.gov/MedicalDevices/Productsand-MedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm095565.htm. Accessed August 2010.

    > Google Scholar
  • 2.Coleman DJ. On the hydraulic suspension theory of accommodation. Trans Am Ophthalmol Soc. 1986; 84:846–868.

    > MedlineGoogle Scholar
  • 3.Strenk SA, Semmlow JL, Strenk LM, Munoz P, Gronlund-Jacob J, DeMarco JK. Age-related changes in human ciliary muscle and lens: a magnetic resonance imaging study. Invest Ophthalmol Vis Sci. 1999; 40(6):1162–1169.

    > MedlineGoogle Scholar
  • 4.Cumming JS, Colvard DM, Dell SJ, Doane J, Fine IH, Hoffmann RS, Packer M, Slade SG. Clinical evaluation of the Crystalens AT-45 accommodating intraocular lens: results of the U.S. Food and Drug Administration clinical trial. J Cataract Refract Surg. 2006; 32(5):812–825.10.1016/j.jcrs.2006.02.007

    > Crossref MedlineGoogle Scholar
  • 5.Findl O, Leydolt C. Meta-analysis of accommodating intraocular lenses. J Cataract Refract Surg. 2007; 33(3):522–527.10.1016/j.jcrs.2006.11.020

    > Crossref MedlineGoogle Scholar
  • 6.Nio YK, Jansonius NM, Fidler V, Geraghty E, Norrby S, Kooijman AC. Age-related changes of defocus-specific contrast sensitivity in healthy subjects. Ophthalmic Physiol Opt. 2000; 20(4):323–334.10.1016/S0275-5408(99)00103-9

    > Crossref MedlineGoogle Scholar
  • 7.Tucker J, Charman WN. The depth-of-focus of the human eye for Snellen letters. Am J Optom Physiol Opt. 1975; 52(1):3–21.

    > Crossref MedlineGoogle Scholar
  • 8.Holladay JT. Refractive power calculations for intraocular lenses in the phakic eye. Am J Ophthalmol. 1993; 116(1):63–66.

    > Crossref MedlineGoogle Scholar
  • 9.Nakazawa M, Ohtsuki K. Apparent accommodation in pseudophakic eyes after implantation of posterior chamber intraocular lenses: optical analysis. Invest Ophthalmol Vis Sci. 1984; 25(12):1458–1460.

    > MedlineGoogle Scholar
  • 10.Mon-Williams M, Tresilian JR, Strang NC, Kochhar P, Wann JP. Improving vision: neural compensation for optical defocus. Proc Biol Sci. 1998; 265(1390):71–77.10.1098/rspb.1998.0266

    > Crossref MedlineGoogle Scholar
  • 11.Schor CM, Kotulak JC, Tsuetaki T. Adaptation of tonic accommodation reduces accommodative lag and is masked in darkness. Invest Ophthalmol Vis Sci. 1986; 27(5):820–827.

    > MedlineGoogle Scholar
  • 12.Cheng X, Himebaugh NL, Kollbaum PS, Thibos LN, Bradley A. Validation of a clinical Shack-Hartmann aberrometer. Optom Vis Sci. 2003; 80(8):587–595.10.1097/00006324-200308000-00013

    > Crossref MedlineGoogle Scholar
  • 13.Thibos LN, Hong X, Bradley A, Cheng X. Statistical variation of aberration structure and image quality in a normal population of healthy eyes. J Opt Soc Am A Opt Image Sci Vis. 2002; 19(12):2329–2348.10.1364/JOSAA.19.002329

    > Crossref MedlineGoogle Scholar
  • 14.Radhakrishnan H, Charman WN. Age-related changes in ocular aberrations with accommodation. J Vis. 2007; 7(7):11.1–21.10.1167/7.7.11

    > CrossrefGoogle Scholar
  • 15.Thibos LN, Applegate RA, Schwiegerling JT, Webb R. Standards for reporting the optical aberrations of eyes. J Refract Surg. 2002; 18(5):S652–S660.

    > LinkGoogle Scholar
  • 16.Tahir HJ, Parry NR, Pallikaris A, Murray IJ. Higher-order aberrations produce orientation-specific notches in the defocused contrast sensitivity function. J Vis. 2009; 9(7):11.10.1167/9.7.11

    > Crossref MedlineGoogle Scholar
  • 17.Ravikumar S, Thibos LN, Bradley A. Calculation of retinal image quality for polychromatic light. J Opt Soc Am A Opt Image Sci Vis. 2008; 25(10):2395–2407.10.1364/JOSAA.25.002395

    > Crossref MedlineGoogle Scholar
  • 18.Chen L, Singer B, Guirao A, Porter J, Williams DR. Image metrics for predicting subjective image quality. Optom Vis Sci. 2005; 82(5):358–369.10.1097/01.OPX.0000162647.80768.7F

    > Crossref MedlineGoogle Scholar
  • 19.Cheng X, Bradley A, Thibos LN. Predicting subjective judgment of best focus with objective image quality metrics. J Vis. 2004; 4(4):310–321.10.1167/4.4.7

    > Crossref MedlineGoogle Scholar
  • 20.Yi F, Iskander DR, Collins MJ. Estimation of the depth of focus from wavefront measurements. J Vis. 2010; 10(4):1–9.10.1167/10.4.3

    > Crossref MedlineGoogle Scholar
  • 21.Legge GE, Mullen KT, Woo GC, Campbell FW. Tolerance to visual defocus. J Opt Soc Am A. 1987; 4(5):851–863.10.1364/JOSAA.4.000851

    > Crossref MedlineGoogle Scholar
  • 22.Campbell CE. Matrix method to find a new set of Zernike coefficients from an original set when the aperture radius is changed. J Opt Soc Am A Opt Image Sci Vis. 2003; 20(2):209–217.10.1364/JOSAA.20.000209

    > Crossref MedlineGoogle Scholar
  • 23.Smith G. Ocular defocus, spurious resolution and contrast reversal. Ophthalmic Physiol Opt. 1982; 2(1):5–23.

    > MedlineGoogle Scholar
  • 24.Atchison DA, Woods RL, Bradley A. Predicting the effects of optical defocus on human contrast sensitivity. J Opt Soc Am A Opt Image Sci Vis. 1998; 15(9):2536–2544.10.1364/JOSAA.15.002536

    > Crossref MedlineGoogle Scholar
  • 25.Strenk SA, Strenk LM, Guo S. Magnetic resonance imaging of the anteroposterior position and thickness of the aging, accommodating, phakic, and pseudophakic ciliary muscle. J Cataract Refract Surg. 2010; 36(2):235–241.10.1016/j.jcrs.2009.08.029

    > Crossref MedlineGoogle Scholar
  • 26.Koeppl C, Findl O, Menapace R, Kriechbaum K, Wirtitsch M, Buehl W, Sacu S, Drexler W. Pilocarpine-induced shift of an accommodating intraocular lens: AT-45 Crystalens. J Cataract Refract Surg. 2005; 31(7):1290–1297.10.1016/j.jcrs.2005.03.055

    > Crossref MedlineGoogle Scholar
  • 27.Sakai H, Hirata Y, Usui S. Relationship between residual aberration and light-adapted pupil size. Optom Vis Sci. 2007; 84(6):517–521.10.1097/OPX.0b013e31806dba43

    > Crossref MedlineGoogle Scholar
  • 28.Allen MJ. The stimulus to accommodation. Am J Optom Arch Am Acad Optom. 1955; 32(8):422–431.

    > Crossref MedlineGoogle Scholar

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