Mechanism of action of the tetraflex accommodative intraocular lens

PURPOSE:To investigate the mechanism of action of the Tetraflex (Lenstec Kellen KH-3500) accommodative intraocular lens (IOL). METHODS:Thirteen eyes of eight patients implanted with the Tetraflex accommodating IOL for at least 2 years underwent assessment of their objective amplitude-of-accommodation by autorefraction, anterior chamber depth and pupil size with optical coherence tomography, and IOL flexure with aberrometry, each viewing a target at 0.0 to 4.00 diopters of accommodative demand. RESULTS:Pupil size decreased by 0.62+/-0.41 mm on increasing accommodative demand, but the Tetraflex IOL was relatively fixed in position within the eye. The ocular aberrations of the eye changed with increased accommodative demand, but not in a consistent manner among individuals. Those aberrations that appeared to be most affected were defocus, vertical primary and secondary astigmatism, vertical coma, horizontal and vertical primary and secondary trefoil, and spherical aberration. CONCLUSIONS:Some of the reported near vision benefits of the Tetraflex accommodating IOL appear to be due to changes in the optical aberrations because of the flexure of the IOL on accommodative effort rather than forward movement within the capsular bag

Factors Influencing Pseudo-Accommodation—The Difference between Subjectively Reported Range of Clear Focus and Objectively Measured Accommodation Range

The key determinants of the range of clear focus in pre-presbyopes and their relative contributions to the difference between subjective range of focus and objective accommodation assessments have not been previously quantified. Fifty participants (aged 33.0 ± 6.4 years) underwent simultaneous monocular subjective (visual acuity measured with an electronic test-chart) and objective (dynamic accommodation measured with an Aston open-field aberrometer) defocus curve testing for lenses between +2.00 to −10.00 DS in +0.50 DS steps in a randomized order. Pupil diameter and ocular aberrations (converted to visual metrics normalized for pupil size) at each level of blur were measured. The difference between objective range over which the power of the crystalline lens changes and the subjective range of clear focus was quantified and the results modelled using pupil size, refractive error, tolerance to blur, and ocular aberrations. The subjective range of clear focus was principally accounted for by age (46.4%) and pupil size (19.3%). The objectively assessed accommodative range was also principally accounted for by age (27.6%) and pupil size (15.4%). Over one-quarter (26.0%) of the difference between objective accommodation and subjective range of clear focus was accounted for by age (14.0%) and spherical aberration at maximum accommodation (12.0%). There was no significant change in the objective accommodative response (F = 1.426, p = 0.229) or pupil size (F = 0.799, p = 0.554) of participants for levels of defocus above their amplitude of accommodation. Pre-presbyopes benefit from an increased subjective range of clear vision beyond their objective accommodation due in part to neural factors, resulting in a measured depth-of-focus of, on average, 1.0

Differences of Longitudinal Chromatic Aberration (LCA) between Eyes with Intraocular Lenses from Different Manufacturers

Several researchers have studied the longitudinal chromatic aberration (LCA) of eyes implanted with an intraocular lens (IOL). We investigated the LCA of eyes implanted with yellow-colored IOLs from three different manufacturers: Alcon Inc., HOYA Corp., and AMO Inc. The number of subjects was 11, 16, and 16, respectively. The LCA of eyes implanted with SN60WF and SN60AT (Alcon Inc.), and with XY-1 (HOYA Corp.), was the same as that of phakic eyes. The LCA of eyes with ZCB00V (AMO Inc.) was smaller than that of phakic eyes. The LCA of eyes implanted with Alcon’s and HOYA’s IOLs, but not the LCA of eyes implanted with AMO’s IOLs, was positively correlated with the powers of the IOLs. We also performed simulations to verify the impacts of LCA on visual performance for 4-mm pupil diameter; the simulations were a polychromatic modulation transfer function (MTF) and a visual Strehl ratio computed on the basis of an optical transfer function (VSOTF). We concluded that the differences between the LCA of different manufacturers do not affect visual performances when some extent of higher-order aberration (HOA) exists. The smaller HOA of AMO IOLs may enhance visual performance