Evaluation of a Novel Zonular Tension Restoring Accommodating Silicone IOL Design: Pilocarpine and Cyclopentolate-Induced Effect 20 Months after Implantation

Purpose. To investigate a novel zonular-stress restoring accommodating 1-piece silicone IOL. Setting. Angeles City, Philippines. Design. Prospective randomized bilateral study. Methods. Each patient received a study IOL (ActaLens™, Emmetrope, La Canada, CA) in one eye and a control IOL (CrystaLens® AO, B&L, USA, or an AcrySof IQ®, Alcon, USA) in the contralateral eye to allow for intraindividual comparison. At the 20-month follow-up, two measurement days were set to measure all eyes before and after instilling 2% pilocarpine on the first day and 1% cyclopentolate on the second measurement day using an optical biometry device (Lenstar, Haag-Streit AG, Switzerland), respectively. PCO was graded by two examiners independently at the slit lamp. Results. In total, 16 eyes of 8 patients were included. In the study group and the control group, the pilocarpine-induced ACD shift was 0.32 mm (SD: 0.12) ( p = 0.014 ) and 0.04 mm (SD: 0.16) ( p = 0.854 ), respectively. In the study group and the control group, the mean cyclopentolate-induced ACD shift was 0.14 (SD: 0.06) ( p = 0.014 ) and 0.03 mm (SD: 0.03) ( p = 0.181 ), respectively. PCO and Nd : YAG rates were higher in the study group, but differences were not found to be significant (AcrySof vs. ActaLens p = 0.100 and CrystaLens vs. ActaLens p = 0.174 ). Conclusion. The investigated IOL is a novel concept for an accommodating IOL, and results showed a moderate pilocarpine-induced forward shift of the IOL 20 months following implantation. For all patients, the investigated IOL seems to have a higher PCO rate compared to standard monofocal IOLs.

Dual–optic Accommodating IOL—A Review

This article reviews the design, development, objective accommodation data, and clinical results of the dual-optic accommodating IOL. The first-generation dual-optic accommodating IOL was designed to interact with the contraction and relaxation of the ciliary muscle to generate accommodation. The more recent aspheric version enhanced this technology to further improve the near benefit. The main advantage of the dual-optic accommodating IOL is the low incidence of problems with contrast, glare, and halos associated with multifocal IOLs. The main criticisms are the lower consistency of visual acuity at near distances and the lower refractive predictability. Newer IOL designs are bringing us closer to the ideal of providing patients with perfect high-quality vision at all distances. The dual-optic accommodating IOL has demonstrated to be a safe alternative to provide very good near and intermediate vision without sacrificing distance visual acuity or quality of vision.