Measurement of accommodation after implantation of an accommodating posterior chamber intraocular lens

Abstract

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