Surgical restoration of accommodation in presbyopia

Abstract

There is considerable and growing interest in understanding if accommodation can be restored to the presbyopic eye. If accommodation is to be restored, this requires a sound understanding of the accommodative mechanism and the causes of presbyopia. Basic physiological studies have over the past decade significant advanced understanding of accommodation and presbyopia and set the stage for exciting future developments. Accommodating intraocular lenses (IOLs) would permit the true, dynamic accommodative capacity to be restored to the presbyopic eye. Accommodative IOLs are designed to be surgically implanted in the eye to induce a change in optical power of the eye consequent to ciliary muscle contraction. Accommodation could be produced in a number of different ways with an IOL including through a forward movement of a single optic IOL, increased separation of dual optic IOLs or through a change in surface curvatures, for example. A number of different designs of so called accommodative IOLs are in early stage development or in clinical trials. An essential aspect to the future success of accommodative IOLs is the need for objective measurements of accommodation to evaluate if these IOLs are capable of accomplishing what is claimed of them, namely restoring accommodation to the presbyopic eye. Although the results have generally been disappointing so far, this is an area of considerable and growing interest and several interesting prospects for restoring true accommodation to the presbyopic eye may be available in the next several years.

Acknowledgments

Supported by NEI/NIH Grant No. R01 EY017076.