Regarding Young's speculations about the change in lens shape with accommodation, we now know that most of the change takes place at the anterior surface (Dubbelman, Van der Heijde, & Weeber,
2005; Rosales, Dubbelman, Marcos, & van der Heijde,
2006) rather than the lens surfaces changing proportionally, as assumed by Young. Instead of the lens diameter not changing with accommodation, it decreases at a rate of approximately 0.05 mm/D (our unpublished data using magnetic resonance imaging). Most studies of the positions of the poles find that the majority of surface movement occurs at the anterior surface (Bolz, Prinz, Drexler, & Findl,
2007; Drexler, Baumgartner, Findl, Hitzenberger, & Fercher,
1997; Dubbelman et al.,
2005; Ostrin, Kasthurirangan, Win-Hall, & Glasser,
2006). It is likely that the changes in refractive index distribution affect accommodation (Gullstrand,
1911; Kasthurirangan, Markwell, Atchison, & Pope,
2008). It has been established many times that the lens is responsible for accommodation although consideration has been given to changes occurring in corneal shape of up to 0.4 D (Pierscionek, Popiolek-Masajada, & Kasprzak,
2001) and in axial length of less than 0.1 mm (<0.3 D accommodation) (Drexler, Findl, Schmetterer, Hitzenberger, & Fercher,
1998; Mallen, Kashyap, & Hampson,
2006). These minor changes may be, at least in part, artifactual due to cyclorotation of the eye affecting the corneal results (Buehren, Collins, Loughridge, Carney, & Iskander,
2003) and assumed refractive indices in the media affecting axial length results (Atchison & Smith,
2004).