A new accommodating lens seems to be a safe option for properly selected patients, in whom excellent refractive results can be achieved.
Dr. Shah presented data from a consecutive case series of 78 eyes that underwent clear lens extraction. The mean patient age was 51 years (range, 43 to 60 years). Thirty eyes were myopic (mean refraction, –12.0 D), and the remainder were hyperopic (mean refraction, +6.5 D), according to Dr. Shah. He is a consultant ophthalmic surgeon at the Birmingham and Midland Eye Centre, Birmingham, and the Midland Eye Institute, Solihull, U.K.
The IOL is a square-edged acrylic lens that can be injected through a 2.8-mm incision. Dr. Shah described the insertion procedure as very easy to perform, with no preoperative or postoperative care requirements.
"The best-corrected visual acuity (BCVA) was about 0 LogMAR. No patients lost a substantial amount of BCVA. One patient lost one line of vision (from 20/15 to 20/20). A large percentage of patients gained BCVA."
Quality of vision
This IOL is a pseudoaccommodative lens. When accommodation was measured with a push-pull technique, Dr. Shah said, "the mean subjective accommodative amplitude was about 2.4 ± 1.0 D 6 months after implantation. The lowest accommodative amplitude was 1.5 D, and the highest was 4.4 D. In another group of patients who underwent cataract extraction, some patients had up to 6.5 D of subjective accommodation."
With this type of IOL, Dr. Shah said, it is difficult to determine exactly how it works. "Objective tests of these lenses with automated refractors show lower values on the same patient than the subjective tests, yet the patients are very happy. So something that we are not measuring well must be happening.
"We achieved extremely good UCVA results with this lens that are comparable with most monofocal IOLs. The results of this study are probably better than most of the studies that have been published," Dr. Shah said. "Patient satisfaction is very high with this IOL. As with most of these types of lenses, most patients achieved very good intermediate vision, and a good percentage had good near vision. At this time, this is my standard lens for clear lens extractions."
The patients who received the IOL 2 years ago are being evaluated to determine the stability of the visual acuity over time, he said.