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The article presents a clinical case of bilateral cataract surgery on megalocornea eyes of a 20-year-old male. The Haigis formula has demonstrated the greatest potential accuracy for IOL calculation in such eyes, while the use of other formulas was associated with a higher risk of significant hyperopic refractive error. An unusually high level of pseudoaccommodation was obtained in both eyes.В статье представлен клинический случай двусторонней хирургии катаракты на глазах с мегалокорнеа у молодого человека 20 лет. Выявлено, что наибольшей потенциальной точностью для расчета оптической силы интраокулярной линзы при мегалокорнеа обладает формула Haigis. При расчете по другим формулам велик риск значительной рефракционной ошибки в сторону гиперметропии. На обоих артифакичных глазах получен необычно высокий уровень псевдоаккомодации.

Oscillopsia associated with near fixation after multifocal intraocular lens (IOL) implantation has not been fully recognized. A 46-year-old woman presented with shaking of vision in both eyes during near fixation after uneventful implantation of a single-piece multifocal posterior chamber IOL in both eyes. There was no sign of zonular weakness in either eye before or during cataract surgery, and the postoperative course was uneventful. Visual acuity was 20/25 in both eyes without correction. There was no IOL oscillation with distant fixation; however, when she changed her focus from a distant to a near object, the IOLs started to oscillate in both eyes, which was assumed to be the cause of her oscillopsia. On cycloplegia, there was no IOL oscillation either with distant or near fixation. A rare cause of oscillopsia associated with pseudoaccommodation after IOL implantation should be recognized.

Introduction: Accommodation is the ability to see over a range of distances by changing the power of the natural lens. With cataract surgery, this ability is partially or completely abolished. Apparent accommodation or pseudo-accommodation is the potential of pseudophakic eyes to sustain a good amount of near vision. Aim: To measure near vision in children with pseudophakia unaided, with distance vision correction alone (mono focal lens) in-situ and to measure the minimum near add (bifocal near segment power) required to read 1M (normal reading print size) at 30 cm and 40 cm. Materials and Methods: A cross-sectional study was conducted among children between 5-15 years of age with pseudophakia. Vision assessment was done using Lea symbol chart, at 3 metres for distance and at 30 cm and 40 cm for near. Near vision assessment was done unaided and with distant vision correction alone in place. Minimum spherical power needed to read 1M and child’s class textbooks were also assessed. Results: Sixty-four children were included in the study. Mean age was 10.5 (±3.12) years. Refractive status showed spherical power ranging from -7.00 DS to +1.00 DS (-0.8 Mean, (±1.33 SD), astigmatism ranging from -4.50 DC to +3.00 DC (-1.29 mean, ±1.37 SD). Unaided near vision assessment showed that 41 (64%) could read

Presbyopia corrections traditionally have been approached with attempts to exchange power, either at the cornea or the lens planes, inducing multifocality, or altering asphericity to impact the optical system. Treatments that affect the visual axis, such as spectacle and contact lens correction, refractive surgeries, corneal onlays and inlays, and intraocular lenses are typically unable to restore true accommodation to the presbyopic eye. Their aim is instead to enhance ‘pseudoaccommodation’ by facilitating an extended depth-of-focus for which vision is sufficient. There is a true lack of technology that approaches presbyopia from a treatment based or therapy based solution, rather than a ‘vision correction’ solution that compromises other components of the optical system. Scleral surgical procedures seek to restore true accommodation combined with pseudoaccommodation and have several advantages over other more invasive options to treat presbyopia. While the theoretical justification of scleral surgical procedures remains controversial, there has nevertheless been increasing interest and evidence to support scleral surgical and therapeutic approaches to treat presbyopia. Enormous progress in scleral surgery techniques and understanding of the mechanisms of action have been achieved since the 1970s, and this remains an active area of research. In this article, we discuss the historic scleral surgical procedures, the two scleral procedures currently available, as well as an outlook of the future for the scleral surgical space for treating presbyopia.

Cataract surgery continues to evolve in several technological aspects. Optical coherence tomography has improved both preoperative biometry and diagnosis. It has been used intra-operatively for particular purposes, and is useful in many postoperative conditions. Automation has entered cataract surgery both through the femtosecond laser and through other mechanized methods of achieving a perfect capsulotomy, with robotic surgery in the pipeline. Feed-back irrigation control during phacoemulsification has been proven effective in stabilizing the anterior chamber and is a leap forward in improving the safety of the surgical procedure. Image-guided toric IOL implantation and refraction-guided power selection are further technical steps in the way to precision. New IOLs have been developed: trifocal IOLs are now the standard of care for multifocality; extended-depth-of-focus IOLs are gaining acceptance and clinical use; pinhole IOLs are also available to improve pseudoaccommodation and to help patients with irregular corneas; supplementary IOLs are challenging the very concept of IOL selection and will be more and more accepted in the near future.

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.

Purpose To compare the performance of accommodative, multifocal, and monofocal intraocular lenses (IOLs). Methods In this clinical control study, 3 types of IOL were implanted in 128 eyes of 86 patients with age-related cataract who underwent phacoemulsification. Accommodative (Tetraflex), multifocal (ZMA00), and monofocal (Akreos Advanced Optics [AO]) IOLs were implanted into 43, 40, and 45 eyes, respectively. The uncorrected, best-corrected distance, contrast sensitivity, and distance-corrected intermediate and near visual acuity (UCDVA, BCDVA, CSVA, DCIVA, and DCNVA, respectively), amplitude of pseudoaccommodation, and patient satisfaction were measured at 1, 3, and 12 months after surgery. Results Differences in CSVA at all contrast degrees, UCDVA, and BCDVA among the 3 groups were not significant. Patients in the Akreos AO group exhibited a poorer DCIVA and DCNVA and experienced less pseudoaccommodation compared to patients in the other 2 groups at 3 and 12 months after surgery (pConclusions All 3 types of IOLs allowed greater distance visual acuity; however, multifocal IOLs produced better DCIVA and DCNVA and more pseudoaccommodation and spectacle independence. Accommodative IOLs ranked second. Neither accommodative nor multifocal IOLs reduced CSVA.

Purpose Today, many patients who have undergone cataract surgery want to enjoy good non-spectacle corrected distant vision and nonspectacle corrected near vision with glasses independence. According to the literature, the implantation of an accommodative intraocular lens (AIOLs) can achieve the level of vision after cataract surgery. However, there is a debate regarding the true accommodative capability of the AIOLs (i.e., whether the IOLs can move forward when attempting to accommodate like the natural crystalline lens of a phakic eye). This review aims to answer the following questions: (1) Can pseudophakic eye accommodate? (2) If pseudophakic eyes can accommodate, how long does this accommodation last? (3) Is there pseudoaccommodation? Methods This is a systematic review of randomized and nonrandomized controlled trials that have compared different IOLs in accommodation using subjective and objective methods of testing accommodation. All peer reviewed randomized and nonrandomized controlled trials that compared different IOLs in accommodation were included. Results There was evidence of pseudophakic accommodation up to 12 months postoperatively for AIOLs (mostly 1CU): subjective accommodation [95% confidence interval (CI), 0.36–0.98], objective optic shift (95% CI, 0.12–0.76). However, accommodation decreased at 12 months postoperatively (95% CI, 0.55–1.00). In addition, several papers have reported evidence of pseudoaccommodation. Conclusion There is pseudophakic accommodation up to 1 year post cataract surgery, mostly 1CU AIOL. Pseudoaccommodation may coexist.

PURPOSE To compare spherical aberration, visual performance and pseudoaccommodation in pseudophakic eyes implanted with aspheric intraocular lenses (IOLs) of Tecnis Z9001 with negative spherical aberration (AMO Inc.), aspheric aberration-free IOLs of Akreos AO (Bausch & Lomb Inc.) and spherical IOLs of KS-1 (Cannon Staar Inc.). METHODS A total of 196 patients presenting for cataract surgery were randomly assigned to receive one of three types of IOLs in one eye. Spherical aberration, best-corrected far visual acuity (BCFVA), distance corrected near visual acuity (DCNVA), contrast sensitivity, glare sensitivity and pseudoaccommodation were measured and compared 3 months postoperatively. RESULTS At 3 months postoperatively, the mean spherical aberration Z(4,0) for 5 mm pupil size in eyes with Tecnis Z9001 IOLs, Akreos AO IOLs, and KS-1 IOLs were 0.022 +/- 0.071 microm, 0.141 +/- 0.070 microm and 0.210 +/- 0.108 microm, respectively (P < 0.001), and significant difference was also found in two aspheric IOLs (P < 0.001). Compared with spherical KS-1 IOLs, Tecnis Z9001 IOLs significantly improved the contrast sensitivity at 4.0 degrees, 2.5 degrees visual angle and glare sensitivity at 4.0 degrees, 2.5 degrees, 2.0 degrees, 1.6 degrees visual angle, Akreos AO IOLs significantly improved contrast sensitivity at 2.5 degrees and glare sensitivity at 4.0 degrees, 2.5 degrees, 2.0 degrees, but no difference statistically significance were found between two aspheric IOLs at any visual angle. In addition, there was no significant difference among three IOLs regarding BCFVA, DCNVA and pseudoaccommodation. CONCLUSIONS All the studied IOLs can provide good visual acuity. Compared with spherical IOLs, both aspheric IOLs can significantly decrease spherical aberration and improve visual performance without the reduction of pseudoaccommodation amplitude.

PURPOSE: To investigate the advantages, clinical outcomes, and safety after implantation of the ICU (HumanOptics AG) optic shift intraocular lens (IOL) in comparison with a conventional monofocal IOL. METHODS: In a prospective non-randomized study, 553 eyes implanted with the ICU IOL were examined. In a control group, a monofocal posterior chamber IOL (MCTE, Dr Schmidt) was implanted in 219 eyes. Follow-up was performed at 1, 6, and 12 months postoperatively. The clinical effect for near visual acuity was evaluated by subjective measurements using an accommodometer, defocusing curve, and Nieden charts. RESULTS: No significant differences were noted in distance best spectacle-corrected visual acuity (BSCVA) between groups. Average near visual acuity with distance BSCVA for the ICU was 0.41 and 0.35 for the control group. The difference in the accommodation response between both groups measured with the accommodometer was 11 cm (P CONCLUSIONS: The 1CU indicates a minor statistical advantage of half a reading step towards monofocal IOLs measured with subjective methods in near point, defocusing curve, and near visual acuity with distance BSCVA. This could be due to Pseudophakie accommodation by the optic shift mechanism or a result of additional Pseudophakic pseudoaccommodation. The accommodative effect of the ICU differed from patient to patient and was not predictable. [J Refract Surg. 2007;23:159-171.]

PURPOSE OF REVIEW This review examines the recent peer-reviewed literature of the past 18 months, with the goal of providing an overview of the pseudophakic lenses designed to provide accommodative action. Accommodative lenses take advantage of axial movement, refractive change and bag filling to provide their effect. Single and dual optic design, as well as unique technologies, were reviewed. RECENT FINDINGS An overview is presented of the various accommodative lenses available for investigation and use. There is positive evidence that current accommodative intraocular lenses provide superior potential for near vision compared with standard intraocular lenses. SUMMARY The available data suggest that accommodative amplitude and pseudoaccommodation are both important factors in the functional ability of accommodative intraocular lenses to provide a range of distance, intermediate and near vision.

PURPOSE: To evaluate the clinical results and safety obtained with a new type of multifocal intraocular lens (IOL) using a trifocal design to achieve pseudoaccommodation. METHODS: A pilot observational study of patients with a trifocal IOL (FineVision; PhysIOL, Liege, Belgium) implanted by 1 of 12 surgeons between March and December 2010. Visual outcomes that were assessed postoperatively included uncorrected and corrected distance, intermediate, and near visual acuity. RESULTS: One hundred ninety-eight eyes of 99 patients were analyzed. Patients were observed for an average of 6.44 ± 4.67 months (range: 0.2 to 17 months). Preoperative corrected distance visual acuity was 0.22 ± 0.26 logMAR. At the final follow-up visit, corrected distance visual acuity was 0.01 ± 0.10 logMAR, uncorrected distance visual acuity was 0.01 ± 0.06 logMAR, uncorrected intermediate visual acuity was 0.08 ± 0.10 logMAR, and mean uncorrected near visual acuity was 0.00 ± 0.04 logMAR. Postoperative binocular uncorrected distance visual acuity was 0.01 ± 0.07 logMAR, uncorrected intermediate visual acuity was 0.06 ± 0.08 logMAR, and uncorrected near visual acuity was −0.03 ± 0.04 logMAR. Postopeative mean residual sphere was 0.21 ± 0.48 diopters (D), with a residual cylinder of −0.24 ± 0.31 D. Postoperative spherical equivalent was 0.11 ± 0.36 D. CONCLUSIONS: The results demonstrated that the trifocal FineVision IOL is able to restore near, intermediate, and distance visual function. [ J Refract Surg . 2014;30(11):762–768.]

Purpose To evaluate the position of posterior chamber intraocular lenses (PC IOLs) at distance and near and the amplitude of pseudoaccommodation in young eyes. Setting Department of Ophthalmology, University School of Medical Sciences, Bydgoszcz, Poland. Methods This study comprised 45 eyes of 38 patients aged 12 to 19 years who had removal of congenital cataract with implantation of a PC IOL. During the follow-up, the refractive error ranged between −1.00 and +1.00 diopter (D), and near visual acuity was 0.75 or 0.50 (Snellen) without additional correction. The position of the PC IOL was measured by A-mode ultrasound at distance and near. Pseudoaccommodation amplitude was calculated using Gullstrand's near-point rule. Results Mean anterior movement of the IOL was 0.42 mm at near. Mean pseudoaccommodation amplitude was 4.50 D. The correlation between these values was significant ( P Conclusion The movement of PC IOLs in young patients may be one reason they attain good near vision without additional correction.

Erfreulicherweise erleben wir in unserer Sprechstunde immer wieder Patienten, die nach Implantation einer Kunstlinse in eines oder beide Augen ohne Brille im taglichen Leben fur Ferne und Nahe auskommen. Nicht mit dem Ziel, eine Brille fur den Pseudophaken uberflussig zu machen, aber doch um das visuelle Wohlbefinden zu heben, wenn die Brille gerade nicht auf der Nase sitzt, wollen die Uberlegungen angestellt sein. In Verbindung damit wird angestrebt, die naturliche Form des Linsenkapselaquators besser zu wahren: Ein besseres Erhaltenbleiben der Topographie der Zonulafasern einerseits und der Erhalt der elastischen Funktion der Zonulabander in der vorderen und hinteren aquatornahen Kapselwand ist durch einen implantierten Ringwulst, der mit einem nach vorne gewinkelten intermediaren, gelochten Ringabschnitt die Optik tragt, eher zu gewahrleisten. Funf Punkte sind es, die eine Pseudoakkommodation ergeben mogen: 1. Die vorgeplante leichte Myopisierung des pseudophaken Auges. 2. Die Erzielung eines leichtgradigen Astigmatismus nach der Regel oder die Verminderung eines solchen gegen die Regel, was mit einem sklerokornealen, fast Clear cornea-Schnitt meist von temporal oder in der entsprechenden Achse angestrebt werden kann. 3. Unterstutzend ist die senile Miose: Eine stenopaische Pupille bringt die Funktion einer Lochkamera. 4. Die Vor- und Ruckwartsbewegung der Linse, eine beim Menschen residual vorhandene Funktion des in der Evolution bekannten Tonnenauges einfacher Fische und Amphibien. 5. Die Implantation einer die etwaige akkommodative Restfunktion ausnutzende Kunstlinse. Sie scheint gerechtfertigt, nachdem der histologische Nachweis des Erhaltenbleibens von meridionalen und zirkularen Fasern des Ziliarmuskels bis ins hohere Alter erbracht ist und die Zonula Zinnii sowie die vordere und hintere Zonulalamelle der Linsenkapsel kaum degenerieren. Ein fur die Implantation in den Kapselsack faltbares Linsenmodell wird vorgestellt. Uber Kurzzeiterfahrung in wenigen Fallen wird berichtet. Die Ergebnisse sind ermutigend. It is satisfying, now and again, to see sometimes patients in our surgery who, after implantation of an artificial lens in one or both eyes, can see well both in near and distant vision without glasses in daily life. These considerations are not intended to make spectacles unnecessary, but with the hope of improving vision without the need to continuously wear them. In connection with this, it is attempted to improve the preservation of the natural shape of the lens capsule at the equator: the maintenance of the topography of the zonular fibres and the elastic function of the circular zonular bonds in the anterior and posterior capsule wall near the equator is more probably ensured by the implantation of a “bulging” ring connected to the optical part of the lens by an intermediate, forward angled perforated ring section. Five points exist which can result in pseudo-accommodation: 1. Precalculation of a slight myopia in the pseudophacic eye. 2. Creating of a slight astigmatism with the rule, or decreasing of such an astigmatism against the rule. This can be achieved through a corneo-scleral, almost clear-cornea incision entering the temporal side or carried out in the appropriate axis. 3. Senile miosis has a supporting effect: a small pupillary aperture increases the depth of field. 4. The zoom-like forwards and backwards movement of the lens. 5. The implantation of an artificial lens capable of making use of any remaining accommodative function. This would seem to be justified after histological proof of retention of meridional and circular fibres of the ciliary muscle even in old age is given and taking into account that Zinn’s zonula and the anterior and posterior zonular lamellae of the lens capsule hardly degenerate at all. A foldable lens, designed for implantation in the capsular bag can be presented. The short-term results from only a few cases can be reported on. The results are encouraging.

In the attempt to manage presbyopia, different intraocular lens designs have been proposed such as monofocal IOLs with monovision or multifocal IOLs. Even though the lenses mentioned offer satisfactory visual results, contemporary ophthalmology has not completely answered the presbyopic dilemma by simulating the accommodative properties of the crystalline lens itself. Accommodative IOLs were designed to fill this gap and provide satisfactory vision for all distances by restoring some degree of “pseudoaccommodation.” Pseudo accommodative capability can be linked to monofocal IOL’s as well but the results are not satisfactory enough to fully support unaided near vision. Pseudoaccommodation is a complex phenomenon that can be attributed to several static (i.e., pupil size, against-the-rule cylindrical refractive error, multifocality of the cornea) and dynamic (i.e., anterior movement of the implant itself) factors. Objective measurement of the accommodative capability offered by the accommodative IOLs is extremely difficult to obtain, and different methods such as autorefractometers, retinoscopy, and ultrasound imaging during accommodative effort, ray tracing, or pharmacological stimulation have been developed but the results are sometimes inconsistent. Despite the difficulties in measuring accommodation, accommodative IOLs represent the future in the attempt to successfully “cure” presbyopia.

35 patients were examined for their pseudoaccommodation 6 to 18 months after cataract extraction and implantation of a diffractive multifocal intraocular lens (MIOL). While in 15 patients a MIOL had been implanted in both eyes 20 patients had a MIOL in one eye only. 45 type 3M 815 LE and 5 3M 825 XE lenses were implanted. The mean age was 58.2 years +/- 9.6 years (33 to 76). Only patients without any pathology except cataract and preoperative refractive errors < +/- 5 diopters of spherical and +/- 1 diopter of astigmatic refraction were eligible for implantation of MIOLs. After estimation of the objective and subjective refraction the patients' pseudoaccommodation was measured by testing their visual acuity, adding lenses of +/- 1, 2, 3, 4, 5 diopters to their best distance correction. All patients with MIOLs reached a visual acuity of 0.4 or better with a maximum peak at 0 and -3 diopters. The visual acuity of the MIOL patients was significantly better in the range of -1 to -4 diopters compared to the results of a control group of patients with monofocal IOLs. This suggests a wider range of pseudoaccommodation in patients with MIOLs.

PURPOSE This study aimed to determine the optimal spherocylindrical refraction in the monofocal, pseudophakic eye using power vectors in dioptric space. METHODS For parallel incident light the defocus of a spherocylinder may be described in dioptric space as: Defocus equivalent for distance fixation = D((SEP,M,x=∞)) = √SEP(2)+(1/2M)(2), where SEP = spherical equivalent power in dioptres (D) and M = astigmatic magnitude in D. In the pseudophakic eye the defocus for any fixation distance x is: Defocus equivalent for the fixation distance x = D((SEP,M,x)) = √(SEP-1/x)(2)+ (1/2M)(2). The cumulative defocus over a fixation interval is the integral of D((SEP,M,x)) . A minimal value for cumulative defocus will indicate a maximal unaided visual acuity (VA) over the chosen fixation interval. We calculated the summated defocus for various spherocylinders for fixation distances ranging from 0.5 m to 6.0 m. RESULTS Minimal cumulative defocus was present for pure spheres of -0.25 D to -0.5 D. No beneficial effect of the presence of astigmatism was detected. CONCLUSIONS In monofocal pseudophakia the highest possible VAs over the most extended fixation ranges may be achieved with slight myopic refractions without astigmatic components.

Megfigyelhető, hogy egyes betegek a szürkehályog-műtét során beültetett monofokális műlencse implantálása után, távoli korrekció mellett is jól használható közeli látásélességet érnek el. Ezt a jelenséget nevezik pszeudoakkomodációnak, aminek megértése és mérése a pseudophakiás szemek akkomodációjának új technikákkal történő pótlása, illetve helyreállítása miatt elengedhetetlen. Célkitűzés: I. A szürkehályog-műtét után megfigyelhető akkomodáció mérése. II. A csarnokmélység mérése Scheimpflug-képalkotással, és az eredmények összehasonlítása a standard, ultrahangos módszerrel. III. Egy új optikai eszköz, az elülső szegmentum optikai koherenciatomográf (Visante OCT) elülsőcsarnok-mélység mérésének eredményeit, illetve annak ismételhetőségét és megbízhatóságát vizsgálni immerziós ultrahangos módszerrel összehasonlítva, phakiás szemeken. Módszer: I. Az akkomodációt defokuszáló módszerrel, parciális koherencia-interferometria módszerével és a szem elülsőcsarnok-mélysége változásának a musculus ciliaris farmakológiai befolyásolása során mértük. II. A szem elülső csarnokának mélységét Pentacammal mértük, és az eredményeket összehasonlítottuk a standard ultrahangos módszerrel phakiás és pseudophakiás szemeken. III. Két vizsgáló mérési eredményeit és azok ismételhetőségét vetettük össze Visante OCT-vel történő elülsőcsarnok-mélység mérése után. Eredmények: I. A defokuszáló technikával 0,83 D-ás teljes akkomodációs amplitúdót igazoltunk. Parciális koherencia-interferometria módszerével a műlencsék elmozdulása fiziológiás akkomodációs inger mellett minimális volt. A musculus ciliaris farmakológiai bénítása során a műlencse átlagosan 0,18 mm-t mozdult előre. II. Phakiás szemeken a Pentacam és ultrahangos módszer eredményei azonosak, pseudophakiás szemeken azonban az optikai módszer lényegesen kisebb csarnokmélységet mér. III. Elülső szegmentum optikai koherenciatomográf az immerziós ultrahangos eszköznél nagyobb csarnokmélységet mér phakiás szemeken. Következtetések: A pseudophakiás szemeken megfigyelhető akkomodációs amplitúdó hátterében álló akkomodáció, illetve pszeudoakkomodáció mérése igen bonyolult, és a különböző módszerekkel csak egy-egy részfolyamat mérhető. A nem kontakt optikai módszerekkel a standard ultrahangos módszerhez képest jelentősen eltérő csarnokmélységek mérhetők. Az elülsőcsarnok-mélység mérésének intra- és interobserver ismételhetősége, valamint megbízhatósága az optikai eszközzel lényegesen jobb.

Purpose Surgeon-controlled centration of IOLs might be an issue when introducing IOL optics yielding additional properties aiming at correcting spherical aberrations, astigmatism and accommodation or pseudoaccommodation. Methods First and third Purkinje reflexes can be used during cataract surgery for the purpose of IOL alignment provided the IOL allows that freedom of action. The bag-in-the-lens (BIL) concept has been designed to add this dimension of freedom to the surgeon. Results When using the Purkinje alignment method, a physiological nasally positioning of the IOL can be observed. Aberrometry shows an increased spherical aberration but no increase of other HO aberrations. Conclusion Surgeon-controlled centration of IOL is possible with the BIL implantation technique. This opens new perspectives for further development and alignment of the optic. Commercial interest

PURPOSE To compare the visual results of presbyLASIK patients to the best theoretical pseudoaccommodation that could be achieved using a multifocal refractive intraocular lens (IOL) model based on the optical structure of a simulated AMO Array multifocal IOL. METHODS The study included 10 hyperopic eyes that underwent central presbyLASIK surgery using a Technovision excimer laser platform. Mean patient age was 57 years, and mean preoperative spherical equivalent refraction was 1.28±0.87 diopters. The optical quality was evaluated by objective distance and near decimal visual acuities calculated using a Fresnel propagation algorithm based on a realistic eye model. Results of the presbyLASIK technique were compared with the theoretical results obtained for the same eye with an ideal, best-fit multifocal IOL (simulated Array multifocal IOL) substituted for the crystalline lens. RESULTS For near objective visual acuity (from 25 cm to 1 m), the ideal, theoretical Array-like lens provided values of visual acuity above 0.5 for all object distances, whereas presbyLASIK also provided good visual responses for distances beyond 45 cm. For distance vision (from 1.5 to 6 m), both the IOL and presbyLASIK visual acuities were over 0.5, but the optical performance of the ideal Array-like lens was slightly worse than with presbyLASIK. CONCLUSIONS Overall near to distance visual acuity obtained with the presbyLASIK technique is comparable to the best visual acuity that could be achieved with a simulated Array multifocal IOL. Near visual acuity with presbyLASIK falls off from the ideal. [J Refract Surg. 2008;24:344-349.] ABOUT THE AUTHORS From the Department of Optics, Universidad de Alicante (Illueca, Mas, Pérez, Espinosa); Instituto Oftalmológico de Alicante, Vissum Corporation (Alió, Ortiz, Sala); and the Division of Ophthalmology, Miguel Hernández University, Medical School (Alió), Alicante, Spain. This study was supported in part by a grant of the Spanish Ministry of Health, Instituto Carlos III, Red Temática de Investigación en Oftalmologia, Subproyecto de Cirugia Refractiva y Calidad Visual (C03/13) and by the Ministerio de Educación y Ciencia through the project nr FIS2005-05053. The authors have no financial interest in the materials presented herein. Correspondence: Jorge L. Alió, MD, PhD, Instituto Oftalmológico Alicante, Vissum Corporation and Division of Ophthalmology, University Miguel Hernández, Avda Denia s/n, Edificio Vissum, 03016 Alicante, Spain. Tel: 34 902 333 344; Fax: 34 965 160 468; E-mail: rdioa@vissum.com Received: October 5, 2006 Accepted: March 16, 2007 Posted online: October 31, 2007

To assess depth of field/depth of focus in pseudophakic eyes as function of visual acuity. Setting: Department of ophthalmology of National Medical Academy of Postgraduate Education. Forty-three pseudophakic eyes of 43 patients after implantation in the capsular bag of monofocal posterior chamber IOLs were examined. All patients had visual acuities at least 20/20 for distance. Visual acuity was examined by charts consisting the Landolt’s rings under defined constant illumination within distance from 3 m to 20 cm from patients’ eyes at various distances with difference of 10 cm (29 measurements). Depth of field was calculated in diopters. The mean value of the depth of field in pseudophakic eyes with pupil diameter of 3 ± 0.3 mm was as follows: 1.12 D for visual acuity 20/20, 0.62 D for visual acuity 20/13, and 0.47 D for visual acuity 20/10. Depth of focus correlates to normal levels of visual acuity. The higher the visual acuity, the lower the depth of focus. The ability of clear vision due to depth of focus-pseudoaccommodation is passive function. Separating the pseudoaccommodation from artificial accommodation in eyes with accommodative IOLs requires strict standardization of methodology especially regarding diameter of pupil, size of test objects, and level of illumination.

Purpose To analyze anterior segment structure changes during accommodative stimuli after monofocal intraocular lens (IOL) implantation using 2 ultrasound biomicroscopy (UBM) systems. Setting Department of Ophthalmology, University of Verona, Verona, Italy. Methods Twenty-six eyes (23 patients) with 1 of 4 monofocal IOL types were studied. Five to 9 months postoperatively, the patients were examined by high-frequency UBM using the HiScan system (Optikon 2000 SpA) and UBM 840 system (Carl Zeiss Meditec). Anterior chamber depth (ACD), iris–zonule distance, anterior chamber angle (ACA), scleral–ciliary process angle, and iris–ciliary process angle were measured using both systems. The iris–ciliary process distance and scleral spur perpendicular–sulcus distance were measured with the UBM 840 system and the sulcus–sulcus distance and capsular bag–IOL position with respect to ciliary process apex, with the HiScan system. Two experienced examiners performed all measurements. Results All parameters except the horizontal iris–ciliary process distance and vertical ACA measured by the UBM 840 system and horizontal ACA by the HiScan system showed significant variation during accommodation. An anterior shift of the IOL–capsular bag ciliary processes–sulcus–zonular iris complex was observed. A simultaneous centripetal shift of ciliary bodies and processes, shown by a reduction in sulcus and capsular bag diameter, was also observed. Conclusion Anterior segment structures demonstrated accommodative movement on UBM after implantation of standard monofocal IOLs.

PURPOSE. To assess depth of focus on the basis of measurements of the point spread function, which involve Stiles and Crawford phenomenon. SETTING. Department of Ophthalmology of National Academy of Postgraduate Education. METHODS. Gullstrand's schematic eye parameters and data of subjective measurement of size of diffusion circles were used for calculation of depth of focus. Data of 1171 eyes with visual acuity 1.0-2.0 were included in the study. RESULTS. Under condition of visual acuity 1.5 data of the depth of focus were 0.38 D, 0.64 D, and 1.92 D for pupil diameter 5.0 mm, 3.0 mm, and 1.0 mm, respectively. Visual acuity 1.0 is characterized by larger value and visual acuity 2.0 by lesser value of the depth of focus. CONCLUSIONS. Depth of focus and normal levels of visual acuity have a close relation: the higher the visual acuity, the smaller the depth of focus.

To distinguish pseudophakic accommodation from pseudoaccommodation by measuring the physiologically and pharmacologically induced anterior chamber depth (ACD) shifts.Department of Ophthalmology, University of Debrecen, Debrecen, Hungary.This study comprised 100 pseudophakic eyes of 79 patients. Forty patients (Group 1) received the AcrySof MA60AC intraocular lens (IOL) (Alcon Laboratories), 50 patients (Group 2) received the SA60AT IOL (Alcon Laboratories), and 10 patients (Group 3) received the apodized diffractive SA60D3 ReSTOR IOL. Visual function was evaluated a mean of 10.2 months +/- 9.2 (SD) postoperatively, and the total pseudoaccommodative amplitude was determined with a defocusing technique. To distinguish pseudophakic accommodation from pseudoaccommodation, ACD measurements were performed using partial coherence interferometry during distance fixation and physiologic accommodation after pharmacologic relaxation of the ciliary muscle.Best corrected distance and near visual acuities were similar in the 3 groups (P = .75 and P = .08, respectively). Distance corrected near visual acuity was significantly better in Group 3 (P.001), with all eyes achieving J1 or better. Three percent in Group 1 and 8% in Group 2 achieved J1 or better. Subjective accommodation was similar in Groups 1 and 2 (-0.82 +/- 0.18 diopter [D] and -1.00 +/- 0.35 D, respectively; P = .3). Group 3 had an accommodation curve with 2 peaks. Intraocular lens movement differences between the groups were not significant (physiologic stimulus: P = .07; cyclopentolate: P = .46), and significant ACD shifts from baseline were not detected (physiologic stimulus: P = .14; cyclopentolate: P = .10).Pseudoaccommodative amplitude of the investigated monofocal IOLs was independent of IOL movement. Anterior shift did not affect good near visual acuity with the AcrySof ReSTOR IOL.

BACKGROUND The Array-MIOL offers the advantage of an increased depth of focus; the aim of our study was to compare other functional results with those of a monofocal IOL. METHODS Uncorrected and corrected distance and near visual acuity were measured in the early postoperative period and after 3 months. Results of contrast acuity (Regan charts) and contrast sensitivity (BVAT II-SG video acuity tester) of the Array-MIOL and a monofocal IOL were compared at the 3-months follow-up. RESULTS Distance visual acuity of the multifocal group did not differ from the monofocal results; uncorrected and distance corrected near acuity were significantly superior in Array patients. The monofocal IOL showed a superior contrast acuity only at the 11% level and a superior contrast sensitivity only at one spatial frequency (20 cpd). Bilateral implantation of the Array-MIOL seems to further improve functional results. CONCLUSION Implantation of the Array silicone multifocal IOL offers the advantage of pseudoaccommodation without relevant impairment of other visual functions.