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Accommodative Arching

Accommodative Arching. Eyeonics Briefing 2 February 2005 Kevin L. Waltz, OD, MD Eye Surgeons of Indiana Indianapolis, IN. Outline of Briefing. Background Measurement limitations Historical assumptions Fortuitous patient Archeological evidence Theory fit with known data.

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Accommodative Arching

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  1. Accommodative Arching Eyeonics Briefing 2 February 2005 Kevin L. Waltz, OD, MD Eye Surgeons of Indiana Indianapolis, IN

  2. Outline of Briefing • Background • Measurement limitations • Historical assumptions • Fortuitous patient • Archeological evidence • Theory fit with known data

  3. Background for AA Theory • KLW’s interest in refractive lens surgery • Tracey experience since summer 2002 • i Trace experience since fall 2003 • Experience with capsular effects on IOL’s • KLW’s frustration with initial AT-45 outcomes • Extensive wavefront testing of distance and near vision with IOL’s, including AT-45 pts

  4. Array Eye for Tracey Review

  5. Experience with Capsular/YAG Effects on Multifocal Optics 10 minutes Pre-YAG Post-YAG 20/20 & J3 20/20 & J1

  6. Experience with Monofocal IOL’s “Pseuodaccommodation”

  7. Measurement Limitations • Original Tracey 64 sequential spots • i Trace sequential 256 spots • Variable spot positioning on Tracey • Tracey can readily measure wavefront at near • Shack-Hartmann simultaneous spots • NIPEK OPD simultaneous topo and wavefront • COAS direct imaging

  8. Historical Assumptions • Near wavefront ignored • Near wavefront assumed to be the same as distance with some amount of uniformly increased power • Reading glasses = accommodation • Low HOA @ distance = low HOA @ near • Low HOA @ near is good

  9. Zachary Waltz 13 yo OD – 5 D accommodation OD – No accommodation

  10. Successful College Student 19yo OS – 5 D accommodation OS – No accommodation

  11. Successful Medical Student S/P LASIK 23 yo OD – 5 D accommodation OD – No accommodation

  12. Fortuitous Patient • 72 year old white male cataract pt • Desired to be less dependent on glasses • Uneventful cataract surgery • PO: Little to no near vision and myopic • Repositioned IOL in bag at 7 weeks to decrease myopia, rotated IOL 90° • Improved distance and near vision

  13. Prior to IOL Rotation

  14. Accommodation with CrystalensS/P IOL Rotation by 90° Distance refractive mapNear refractive map 0.186 rms total error 0.464 rms total errror 0.69+0.36X078 -2.37+0.92x008

  15. Crystalens Accommodative Arching

  16. AA at a Different Meridian 8:46

  17. AA at a Different Meridian 8:47

  18. AA Relaxed 8:52

  19. AA relaxed 8:53

  20. AA at Maximum 10 Diopters 8:54

  21. Archeologiccal Evidence“The aberrations in some Tracey images are not compatible with high quality vision.”

  22. Archeologiccal Evidence

  23. Archeologiccal Evidence46 yo Optometrist

  24. Phakic Patients have AA33 yo WF Preop Cataract

  25. 50 yo Optometrist Preop Cataract

  26. 17 yo Son of Optometrist

  27. 17 yo w/ 5 Diopters Stimulus& 3.25 Diopters AA Response

  28. 50 yo Optometrist Dilated PO #1

  29. 50 yo Optometrist Dilated PO Week 3

  30. 48 yo Prelex Preop Distance

  31. 48 yo Prelex Preop Near1.25 Diopters of “Accommodation”

  32. AA Theory Fit With Known Data • Images are almost certainly real • Axial movement of 0.3 mm needed for 10 D of AA flexing over 2mm diameter • Variations in Crystalens orientation relative to power axis in eye would create inconsistent measured near vision in patients • Capsule effects might change with time

  33. AA Theory Fit With Known Data Variations in IOL power with AA and emerging concept of neuroplasticity could explain inconsistency in measured accommodation vs observed near vision

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