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Benefits and barriers of accommodating intraocular lenses

Pepose, Jay S.; Burke, Joshua; Qazi, Mujtaba A.

Current Opinion in Ophthalmology: January 2017 - Volume 28 - Issue 1 - p 3–8
doi: 10.1097/ICU.0000000000000323

Purpose of review Presbyopia and cataract development are changes that ubiquitously affect the aging population. Considerable effort has been made in the development of intraocular lenses (IOLs) that allow correction of presbyopia postoperatively. The purpose of this review is to examine the benefits and barriers of accommodating IOLs, with a focus on emerging technologies.

Recent findings True accommodation of an IOL involves a dynamic increase in dioptric power to affect a shift from distance to intermediate or near focus. The Crystalens (Crystalens Bausch and Lomb, Inc., Rochester, NY, USA) was the first IOL labeled by the FDA as an accommodating IOL. Further studies have suggested that the Crystalens and several other single optic presbyopia-correcting IOLs may be providing improved intermediate or near vision predominantly through pseudoaccommodative mechanisms, in addition to small changes in axial translation. In light of these findings, a more objective demonstration of accommodation is now required for an IOL to have an accommodative label. Newer technology accommodating IOLs in development have embraced design strategies using dual optics, shape-changing optics, and IOLs with dynamic changes in refractive index. Prevention and treatment algorithms for capsular contraction syndromes unique to Crystalens and Trulign IOL designs will be discussed.

Summary Accommodating IOLs that are in current use are constrained by their low and varied amplitude of accommodation. Such limitations may be circumvented in the future by accommodative design strategies that rely more on shape-related changes in the surfaces of the IOLs or in dynamic changes in refractive index than by forward translation alone.

aPepose Vision Institute, Chesterfield

bDepartment of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA

Correspondence to Jay S. Pepose, MD, PhD, Pepose Vision Institute, Department of Ophthalmology and Visual Sciences, 1815 Clarkson Road, Chesterfield, MO 63017 USA. Tel: +1 636 728 0111; e-mail:

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