PubMed · 12153786
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Ronald A Schachar. 2002. Presbyopia, accommodation, and mature catenary.. https://doi.org/10.1016/s0161-6420(02)01142-9
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An empirically based, conceptual model of human blur perception is presented. It incorporates the concepts of blur detection and blur discrimination in depth, and across the central and peripheral retina, in two- and three-dimensional visual space. Key aspects of the model are its dynamic nature, predictability regarding the blur-based depth-ordering of objects, patterns of retinal defocus with far and near viewing, and interactions related to retinal defocus between the central and peripheral retina. Furthermore, a two-dimensional schematic representation of the blur-free region during near viewing is depicted in dioptric space. This model has implications with respect to accommodative control, depth perception, and refractive error development and progression.
AIM: To determine the effect of human in vivo accommodation on the stability of the crystalline lens. METHODS: Using a dual Purkinje image (DPI) eyetracker, the phase-time difference and amplitudes of Purkinje images I (P(I)) and IV (P(1V)) were measured in 37 normal emmetropic subjects (34 women and 3 men; mean age 19.8, range 18-22 years) when they changed focus from 70 to 15 cm and simultaneously rotated their heads horizontally from side to side or made horizontal saccades between two targets 6.8 degrees apart. RESULTS: When the subjects changed focus from 70 to 15 cm and rotated their heads or made eye saccades, the phase-time difference between P(I) and P(IV) decreased. During saccades, the amplitude of both P(I) and P(IV) overshoots significantly increased with focus at 15 cm; however, their ratio (P(IV) overshoot amplitude/P(I) overshoot amplitude) significantly declined. CONCLUSIONS: The lens is stable during accommodation. The implications of these findings on the mechanism of accommodation are discussed.
PURPOSE: To evaluate the clinical outcomes of an accommodating dual-optic intraocular lens (IOL). SETTING: Private practice and university centers. METHODS: 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. 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. RESULTS: Twenty-four eyes were available at the 6-month follow-up visit. All eyes had best corrected distance visual acuity of 20/40 or better, and 19 eyes (79%) had an uncorrected distance visual acuity of 20/40 or better. Uncorrected near visual acuity was 20/40 or better in all eyes. With distance correction, 23 eyes (96%) had an acuity of 20/40 or better at near. Defocus curve analysis suggested a mean accommodative range of 3.22 diopters (D) +/- 0.88 (SD) (range 1.00 to 5.00 D) in the accommodating IOL group and 1.65 +/- 0.58 D in the control group (range 1.00 to 2.50 D) (P<.05). CONCLUSION: The Synchrony dual-optic IOL shows promise as an option to provide accommodative function in pseudophakic patients.