Reply: Inclusion of nonchanging positional references
I do not think Schachar's findings are completely right. In fact, analyzing the cited images, I do not find a thicker central optic in Figure 1. In Figure 2, the anterior curvature of the IOL appears to be flatter during accommodation, but that is explained by the tilt of the IOL consequent to the contraction of the ciliary muscles, whose action deforms the profile of the IOL loops, as shown by the arrows; it is evident that contraction of ciliary muscles determines movement of the IOL and that appearance is not due to a variation in the UBM imaging acquisition plane between the nonaccommodative state and the accommodative state. These phenomena are even more evident in Figure 3, in which IOL tilting is more pronounced. In that image (Figure 3, B), the IOL optic disc appears thicker because the imaging acquisition plane is slightly diagonal because the IOL moved during accommodation.© 2009 by Lippincott Williams & Wilkins, Inc.