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20-May-2020 22:01

Accommodating IOLs hold the promise of providing good distance, intermediate, and near acuity with fewer optical aberrations than currently available multifocal IOLs.Dual-optic accommodating IOLs provide greater accommodative amplitudes than single-optic accommodative lenses but are also slightly more challenging to implant.Defocus curves in the accommodating IOL group were compared with those in the control group.The main outcome measures were postoperative distance uncorrected and best corrected visual acuity; near uncorrected, distance corrected, and near corrected visual acuity; and accommodative range based on defocus curves.At that point, the lens will completely fill the capsular bag—and you can't really see the rear optic, which is obscured by the front optic—and the surgeon uses bimanual irrigation/aspiration to completely remove the OVD, which includes any amount sandwiched between the two optics."The results from the Synchrony's FDA trial of nearly 450 implantations at 20 investigator sites are currently being tabulated and aren't available for publication. Alarcon-Jimenez, however, implanted 84 lenses in 42 patients, and has two years of follow-up in 22 implantations."At 24 months, over 95 percent of the cases had 20/40 or better distance vision," Dr. "All had better than 20/34 intermediate visual acuity and 95 percent had 20/40 or better near visual acuity." At two years, 85 percent can use the computer or read a newspaper without spectacles., once the trial data is submitted it will then be in the FDA's hands, but Dr. "I think clinicians are looking forward to having newer, and hopefully better, accommodating IOL options," he says.A prospective noncomparative case series with retrospective control comprised 21 patients (26 eyes) scheduled for small-incision extracapsular cataract extraction by phacoemulsification with implantation of the Synchrony dual-optic accommodating IOL (Visiogen) (accommodating IOL group) and 10 patients who had small-incision extracapsular phacoemulsification with implantation of a monofocal, single-optic IOL at least 6 months previously (control group).Patients were examined 1, 3, 6, and 12 months after surgery.

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The injector requires a larger incision than for current monofocal IOLs, and I prefer about a 3.7- to 3.8-mm incision, as measured with an incision gauge.""The capsulorhexis must be small enough to completely overlap and restrain the forward-moving anterior optic," Dr. "If the capsulorhexis is too large, or it's eccentric so that it fails to overlap one part of the anterior optic edge, you can't insert the lens."The surgeon also has to get visually oriented as to what part of which optic is emerging out of the injector first," Dr. "Typically, you have to make minor manipulations to properly position the two optics.

"What varies is how much minus is in the rear optic, while the anterior optic is greater than 30 D in every eye.""The Synchrony operates according to the Helmholtz mechanism of accommodation," he explains, "with tensing and relaxation of the zonules in response to ciliary muscle contraction and relaxation.