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An accommodating IOL provides excellent visual results in patients with hyperopia or myopia.
Dr. Carter, in private practice in Dallas, undertook a study of 1,978 eyes to determine whether the lens works in patients who have extraordinarily long or short axial lengths and whether it works with very low- and very high-power lens implant powers, considering the proposed mechanism of action of the lens implant. The accommodating lens comes in a range of powers-from 4 to 33 D-that is larger than that of multifocal lens implants, he said.
It is important to note that these results are monocular outcomes only, Dr. Carter said, adding that some deliberate planned myopic targeted refractive outcomes were included in these data.
"When the [lens] was evaluated in hyperopic patients between plano and +3.0 D, the UCDVA, the UCIVA, and the UCNVA were compared with the 20/25, 20/30, and 20/40 metrics," he said. Eighty-five percent of the hyperopic patients had UCDVA of 20/40 or better, 97% had 20/40 UCIVA or better, and 92% had 20/40 UCNVA or better, he added, and 65% of patients had 20/25 UCDVA or better, 92% had 20/25 UCIVA or better, and 64% had 20/25 UCNVA or better.
In the group of patients with very high hyperopia, he said, the numbers "dramatically improved," with 78% of patients having UCDVA of 20/25 or better, 96% having UCIVA of 20/25 or better, and 75% having UCNVA of 20/25 or better. Ninety-one percent had 20/40 or better at distance, 100% had UCIVA of 20/40 or better, and 94% had UCNVA of 20/40 or better.
Statistical improvement in the myopic eyes was less than that seen in hyperopic eyes; nonetheless, Dr. Carter described the results as "impressive." Fifty-one percent of patients had 20/25 UCDVA or better, 91% had UCIVA of 20/25 or better, and 62% had UCNVA of 20/25 or better. Eighty-one percent had 20/40 or better UCDVA, 97% had 20/40 or better UCIVA, and 88% had 20/40 or better UCNVA. The UCDVA data were adversely affected by planned myopic refractive outcome targets, he said.
"The hyperopic patients did slightly better than the myopic patients, especially in the near and intermediate visual acuity levels. This occurred despite slightly hyperopic outcomes," Dr. Carter said. "The normal target for the accommodating [lens] is not hyperopic but typically slightly myopic."
No lenses were explanted in either group for any reason, he added.