Accommodative intraocular lenses: where are we and where we are going

Abstract

Presbyopia still remains the last frontier of refractive surgery. Its surgical management is under constant evolution due to the limitations that exist today with respect to its management, which is probably in relation with the multifactorial basis in which presbyopia is clinically developed in the human. Until currently, virtually all surgical techniques that have been proposed for its correction are based on the induction of pseudoaccommodation in the presbyopic eye, including multifocality. However, the real restoration of accommodation is more complex, and it has been tried by the use of different, so called, “accommodative” pseudophakic intraocular lenses (AIOL). Overall, the reported results with these lenses by independent authors have been modest in relation with the restoration of the accommodative power of the eye and these modest benefits are usually lost with time due to the long term changes in the capsular bag. This fact made these lenses to be almost abandoned in the last few years, but there are currently other AIOL models being used with innovative mechanisms of action and different anatomical support outside the capsular bag that offer encouraging preliminary results that could bring a new potential of application to these types of lenses.In this article, we will update the modern refractive surgeon about the fundamentals and provide updated information about the outcomes of AIOLs by reviewing the concept of accommodation, the different attempts that have been accomplished in the past, their demonstrated published results in human clinical trials, and the future alternatives that may arrive in the near future.

A Comparative Study of Two Different Accommodative Intraocular Lenses: The Visual and Accommodative Amplitude Outcomes

“…Presbyopia is one of the most important problems in older patients with or without cataract (1)(2)(3)(4)(5)(6)(7). Spectacles, multifocal contact lenses, and several surgical treatment approaches were being used for the 'correction' of presbyopia (5)(6)(7)(8)(9)(10). Presbyopia correction during cataract surgery is one of the important goals of anterior segment surgeons (5).…”

“…Alternatively, AIOLs are likely to mimic the accommodation reflex conceptually (5)(6)(7)(8). There are three main types of AIOLs: single optic AIOLs, dual-optic AIOLs, and capsular bag refilling AIOLs (7,8). Single optic designs work with accommodative effort, which is called as the focus-shift principle (7,8).…”

“…There are three main types of AIOLs: single optic AIOLs, dual-optic AIOLs, and capsular bag refilling AIOLs (7,8). Single optic designs work with accommodative effort, which is called as the focus-shift principle (7,8). The lens optic of moves forward by contraction of the ciliary muscle, thereby increasing the refractive power of the IOL for better near vision (7,8).…”

Contributions of shape and stiffness to accommodative loss in the ageing human lens: a finite element model assessment

“…The gradual decrease in accommodation with age follows a wellrecognised trend [1,2] although rates are known to vary with individuals. Reading glasses remain the common method of dealing with presbyopia; a number of attempts have been and continue to be made to develop accommodative intraocular lenses [3,4]. Success is limited because of a lack of understanding of how presbyopia develops and how different ocular components involved in accommodation may contribute to the process, as well as difficulties in determining a suitable material model of the eye lens and current limitations in surgical techniques.…”

Risk of falls and injuries requiring hospitalisation after first‐eye cataract surgery in elderly Australians

“…Currently, the use of accommodative IOLs is very limited because of the low amplitude of accommodation and the uncertainty if lasting effect can be achieved (Alió et al. ); thus, we did not include them in the study.…”