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Visual Performance of Accommodating IOLs: How Does a Dual Optic Compare With a Single Optic?

Visual Performance of Accommodating IOLs: How Does a Dual Optic Compare With a Single Optic?. GEORGE H.H. BEIKO, B.M.,B.Ch.,FRCSC ST. CATHARINES, CANADA ASSIST PROF, MCMASTER UNIV LECTURER, UNIV OF TORONTO Consultant to AMO USAMA MOURIS BEBAWY, MB MBCh CLINICAL FELLOW, MCMASTER UNIV

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Visual Performance of Accommodating IOLs: How Does a Dual Optic Compare With a Single Optic?

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  1. Visual Performance of Accommodating IOLs: How Does a Dual Optic Compare With a Single Optic? GEORGE H.H. BEIKO, B.M.,B.Ch.,FRCSC ST. CATHARINES, CANADA ASSIST PROF, MCMASTER UNIV LECTURER, UNIV OF TORONTO Consultant to AMO USAMA MOURIS BEBAWY, MB MBCh CLINICAL FELLOW, MCMASTER UNIV No Financial Disclosure

  2. Introduction: • Ability to see at near is dependent upon accommodation (lens displacement, shape change and refractive power change) and pseudoaccomodation (pinhole effect, residual myopia, with the rule astigmatism, corneal multifocality due to higher order aberrations such as spherical aberration, and depth of field) • Pseudoaccommodation can provide 1.5-2.0 D of accommodative power in most eyes • To evaluate the accommodative effect of a pseudophakic lens, it is essential to control for pseudoaccommodation Would JE, Hu A, Chen S, Glasser A. Subjective and objective measurement of human accommodative amplitude. J Cataract Refract Surg 2003; 29: 1878-88. Ostrin LA, Glasser A. Accommodation measurements in a prepresbyopic and presbyopic population. J Cataract Refract Surg. 2004; 30: 1435-44.

  3. Purpose: • To compare vision in patients with bilateral B&L Crystalens HD, and AMO Synchrony Dual Optic Accommodating IOLs

  4. B & L Crystalens HD Visiogen/AMO Synchrony Dual Optic IOL • Dual optic connected by spring haptics Theoretical accommodation: 3.3 (D) with 1.5mm of anterior lens movement • Single-piece, latest generation silicone • Overall size: 9.5 x 9.8mm • 5.5mm high plus (+ 32 D) anterior optic coupled with a 6.0mm minus posterior optic to provide prescribed emmetropia power • Ref. Index of 1.43 • Biosil, Refractive Index 1.427 • Non UV-blocking 5.0mm optic, 11.5- 12.0 mm Overall Diameter • Plate haptic design with polyimide haptics • +10.0 D to +33 D in 0.5 D increments • Biconvex design of optic • “Proprietary optic design modification to increase depth of focus while providing a single image to the retina” • Only lens to be labeled as an accommodating IOL by FDA

  5. Methods: • One surgeon, similar technique and post-op care in all cases • Patients groups were taken from concurrent studies; one comparing accommodating IOLs and the other a prospective study of a dual optic accommodating IOL • Capsulorhexis greater than optic with B&L Crystalens HD; smaller than optic with AMO Synchrony dual optic IOL • Target refraction (as recommended by manufacturers) +0.25D hyperopia for B&L Crystalens HD and emmetropia for AMO Synchrony dual optic IOL

  6. Methods: • Pupil diameter was measured with Neuroptics Pupillometer • Vision tested at 6 months post-op, ensuring distance corrected for target refraction • Vision tested using EDTRS charts at 4 M, 70 cm and comfortable near distance • ANOVA used to compare readings

  7. Patient Profile:

  8. Vision, EDTRS Charts, Both EyesBest Distance Corrected:

  9. Conclusions: • Pseudoaccommodation was controlled as study patient parameters (pupil diameter, residual refraction, lack of astigmatism) were similar for B&L Crystalens HD and AMO Synchrony Dual Optic Accommodating IOL groups • The Synchrony Dual Optic Accommodating IOL provided a superior range of vision with 20/20 vision at all distances measured when compared to the Crystalens HD single optic IOL (which only achieved 20/40+ vision at near), and this despite the dual optic IOL group being 10 years of age older on average.

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