1. Comparison of vision with an accommodating IOL versus a multifocal IOL
GEORGE H.H. BEIKO, B.M.,B.Ch.,FRCSC
ST. CATHARINES, CANADA
ASSIST PROF, MCMASTER UNIV
LECTURER, UNIV OF TORONTO
Financial Disclosure:
Abbott Medical Optics – Consultant, Research support
Visiogen, Inc. - Research support
Lenstec/Clarion - Research support

2. Introduction:
Ability to see at near is dependent upon accommodation (lens displacement, shape change and refractive power change) and pseudoaccomodation (pinhole effect, residual myopia, with the rule astigmatism, corneal multifocality due to higher order aberrations such as spherical aberration and depth of field)
Pseudoaccommodation can provide D of accommodative power in most eyes
To evaluate the accommodative effect of a pseudophakic lens, it is essential to control for pseudoaccommodation
Would JE, Hu A, Chen S, Glasser A. Subjective and objective measurement of human accommodative amplitude. J Cataract Refract Surg 2003; 29:
Ostrin LA, Glasser A. Accommodation measurements in a prepresbyopic and presbyopic population. J Cataract Refract Surg. 2004; 30:

3. Purpose:
To compare vision in patients with bilateral B&L Crystalens HD, and AMO Tecnis Multifocal Acrylic IOLs, after controlling for pseudoaccommodation

4. AMO TECNIS® Multifocal Acrylic IOL
B & L
Crystalens HD
Hydrophopic acrylic, Refractive Index 1.47
UV-blocking 6.0 mm optic,13.0mm Overall Diameter
OptiEdge design
3 piece design with PMMA haptics
+5 D to +34 D in 0.5 D increments
Optical power add +4.0D
+3.00 at spectacle plane
Full diffractive posterior surface
Pupil-independent
Wavefront-designed aspheric anterior surface
Biosil, Refractive Index 1.427
Non UV-blocking 5.0mm optic, mm Overall Diameter
Plate haptic design with polyimide haptics
+10.0 D to +33 D in 0.5 D increments
Biconvex design of optic
“Proprietary optic design modification to increase depth of focus while providing a single image to the retina”
Only lens to be labeled as an accommodating IOL by FDA

5. Methods: One surgeon, similar technique and post-op care in all cases
Patients groups were taken from concurrent studies; one comparing accommodating IOLs and the other comparing multifocal IOLs
Capsulorhexis greater than optic with Crystalens HD; smaller than optic with Tecnis MF Acrylic IOL
Target refraction (as recommended by manufacturers) D hyperopia for B&L Crystalens HD and emmetropia for AMO Tecnis MF Acrylic

6. Methods:
The Oculus Easygraph was used to measure the spherical aberrations of the anterior corneal surface
Pupil diameter was meaured with Neuroptics Pupillometer in Crystalens HD group, and Colvard Pupillometer in Tecnis MF Acrylic group
Vision tested at 8 or more weeks post-op, ensuring distance corrected for target refraction
Vision tested using EDTRS charts at 4 M, 70 cm and comfortable near distance
Contrast sensitivity was measured using Vector Vision CSV 1000
ANOVA used to compare readings

7. Patient Profile: B&L Crystalens HD AMO Tecnis Acrylic MF P value
Number 10
Age (years)
/- 4.76
69.1 +/- 8.2
0.670
Spherical Aberr. (microns) / /
0.594
Photopic Pupil (mm)
3.03 +/- 0.42
3.44 +/- 0.53
0.484
Mesopic Pupil (mm)
4.49 +/- 0.51
4.56 +/- 0.73
0.904
IOL Power Implanted (D)
/- 3.60
/- 3.08
0.257
By controlling for age, corneal spherical aberration, pupil size IOL power and astigmatism (all patients had < 1D or corneal astigmatism), pseudoaccomodation should be similar in both groups

8. Vision, Both Eyes Best Distance Corrected, using EDTRS Charts:
B&L Crystalens HD
AMO Tecnis Acrylic MF
P value
Vision (EDTRS) 9
Distance
(4 M)
/- 4.60
(20/20-)
/- 6.22
0.862
Intermediate
(70 cm)
/- 8.99
(20/25-)
/- 5.10
0.963
Near
/- 7.07
(20/40+)
/- 5.52
(20/25+)
0.016
The data shows that the study groups were comparable, except for the value of SA. 8

9. Photopic Contrast Sensitivity:
The data shows that the study groups were comparable, except for the value of SA.
B&L Crystalens HD
AMO Tecnis Acrylic MF
P value
Spatial Freq. 9 3
7.50 +/- 0.76
7.11 +/- 1.54
0.527 6
7.13 +/- 1.13
6.22 +/- 2.77
0.405 12
7.00 +/- 1.93
5.44 +/- 3.47
0.280 18
6.75 +/- 1.83
5.56 +/- 2.96
0.341

10. Mesopic Contrast Sensitivity:
The data shows that the study groups were comparable, except for the value of SA.
B&L Crystalens HD
AMO Tecnis Acrylic MF
P value
Spatial Freq. 9 3
7.38 +/- 1.06
7.11 +/- 1.97
0.740 6
6.00 +/- 2.62
5.56 +/- 2.40
0.720 12
4.50 +/- 3.82
5.44 +/- 2.70
0.561 18
3.88 +/- 2.80
4.44 +/- 2.07
0.638

11. Conclusions:
Pseudoaccommodation was controlled as study patient parameters were similar for B&L Crystalens HD and AMO Tecnis Multifocal Acrylic IOL groups
Distance and intermediate vision was similar in the two groups, but near vision was significantly better for Tecnis MF Acrylic (20/25+) vs Crystalens HD (20/40+)
Quality of vision (photopic and mesopic contrast sensitivity) was similar in all groups
AMO Tecnis Multifocal Acrylic IOL provides significantly better near visual acuity without any signifcant decrease in contrast sensitivity, than B&L Crystalens HD