1. *Center for Excellence in Eyecare
Open-Label Evaluation of Degree of Accommodation in Pseudophakic Patients With Bilateral Monofocal Intraocular Lenses
Daniel R. Neal, PhD**
Pinar Haytac*
**Employees of Abbott Medical Optics
William Trattler, MD*
*Center for Excellence in Eyecare
Miami, FL
Measurements
Wavefront
Refraction
Pupil size
6 readings per second 1

2. Financial Disclosure:
William Trattler: Consultant/Research Funding &/OR Speaking Honoraria: AMO, Lenstec, Wavetec
Pinar Haytac: No Disclosures
Daniel R. Neal, PhD: Employee of Abbott Medical Optics

3. 30 yr old phakic patient 6 D of accommodation measured on COAS wavefront aberrometer
3/18/ :06 Phakic OS /19/
12 second video showing wavefront aberrometry with COAS
0-4 seconds: Distance target
5-8 seconds: Near Target
9-12 seconds: Distance Target
Presentation Title:Quantitative measurement of accommodation in pseudo-phakic eyes with a wavefront aberrometer
2009/04/06

4. Phakic accommodation follows normal age curve, and is reproducible
All Phakic Eyes
We excluded data where the pupil did not respond to the accommodating stimulous. Usually this was indicative that the subject either couldn’t see the target, or didn’t attempt to focus on it.
N = 27 eyes
Age range 22-51
Spherical Equivalent: to +5.00
When spherical aberration is subtracted
Reproducibility improves
8 eyes were measured 5 times each
The SA contribution amounts to about 17%

5. Total Accommodation
Total Accommodation – SA Spherical Aberration Subtracted from Total Accommodation
Phakic A A
Pseudophakes
Pseudophakes
Pseudophakes
Pseudophakes
Pseudo-phakic eyes show very little evidence of objective accommodation
Total Accommodation (D)
Total Accommodation (D) – SA Contribution
Crystalens
Crystalens
Crystalens HD
Crystalens HD
Tetraflex
Tetraflex
Total accommodation is large on young phakics and a few pseudophakics.
When SA is subtracted, no true focus changes occur on pseudophakics. 5

6. 89 year old with Crystalens HD
12 Second Evaluation with COAS wavefront aberrometer
12/16/ :32 Crystalens HD520 OD /21/
Total Accommodation
Accommodation w/o SA
12 second video showing wavefront aberrometry with COAS
0-4 seconds: Distance target
5-8 seconds: Near Target
9-12 seconds: Distance Target
When Spherical aberration is subtracted from the wavefront, there is little change in refraction during accommodation
Accommodation for this 89 year old pseudophakic is predominantly due to the spherical aberration contribution.
Presentation Title:Quantitative measurement of accommodation in pseudo-phakic eyes with a wavefront aberrometer
2009/04/06

7. Central 3mm of 43 year old Crystalens 5.0 patient
Refraction change during attempted accommodation is related to pupil size
-More SA in central OZ
PATIENT RF, OD Male 43 YO
SA: Mypopic shift, but reduced quality of Vision

8. Conclusions
Objective accommodation can be measured accurately with a dynamic wavefront aberrometer
Initial analysis found minimal objective accommodation in pseudo-phakic subjects
Pseudo-accommodation:
Spherical Aberration: Mypopic shift, but at the expense of quality of vision