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

GEORGE H.H. BEIKO, B.M.,B.Ch.,FRCSCST. CATHARINES, CANADAASSIST PROF, MCMASTER UNIVLECTURER, UNIV OF TORONTOConsultant to AMO

USAMA MOURIS BEBAWY, MB MBChCLINICAL FELLOW, MCMASTER UNIVNo Financial Disclosure

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.

Purpose:

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

Visiogen/AMO Synchrony Dual

Optic IOL

• Dual optic connected by spring hapticsDual optic connected by spring haptics Theoretical accommodation:Theoretical accommodation: 3.3 (D) with 1.5mm of anterior lens movement3.3 (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

B & L Crystalens HD

• 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

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

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

Patient Profile:

B&L Crystalens HD

AMO Synchrony

P value

Number 10 11Age 67.80 +/- 4.76 77.27 +/- 9.68 0.011Photopic Pupil 3.03 +/- 0.42 3.58 +/- 0.60 0.308Mesopic Pupil 4.49 +/- 0.51 4.78 +/- 0.91 0.800IOL Power 21.93 +/- 3.60 21.80 +/- 1.80 0.931

Vision, EDTRS Charts, Both EyesBest Distance Corrected:

B&L Crystalens HD

AMO Synchrony

P value# of Patients 9 11

Vision (EDTRS)

Distance (4 M)

38.25 +/- 4.60(20/20-)

38.18 +/- 2.18(20/20-) 0.700

Intermediate(70 cm)

63.50 +/- 8.99(20/25-)

68.27 +/- 7.14(20/20-) 0.202

Near 57.38 +/- 7.07(20/40+)

69.73 +/- 8.26(20/20-) 0.002

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.