Aberrometry in patients implanted with accommodative intraocular lenses.

PURPOSE To evaluate the objective accommodative response, change of aberrations, and depth of focus in eyes implanted with the Crystalens accommodative intraocular lens (IOL) at different accommodative demands. DESIGN Prospective, observational study. METHODS Eleven cataract patients (22 eyes) who underwent implantation of a Crystalens accommodative IOL, and control groups of 9 normal subjects (17 eyes) and 17 pseudophakic patients (17 eyes) implanted with monofocal IOLs were evaluated. A custom-developed laser ray tracing aberrometer was used to measure the optical aberrations. The monochromatic wave aberrations were described using a sixth-order Zernike polynomial expansion. Measurements were obtained under dilated and natural viewing conditions (for accommodative efforts ranging from 0 to 2.5 diopters [D]). The accommodative response was obtained by analyzing changes in paraxial defocus (associated to changes in defocus) and by evaluating the differences in the effective defocus (associated with defocus, spherical aberrations, and pupil diameter) with the accommodative demand. Depth of focus was estimated from through-focus objective optical quality. RESULTS Wave aberration measurements were highly reproducible. Vertical trefoil (Z3(-3)) was the predominant higher-order aberration in the Crystalens group and significantly higher (P < .0001) than in the young group, but similar to the monofocal IOL group. The coma root mean square also was higher (P < .005) in the Crystalens group than in the young group. On average, the defocus term (Z2(0)), astigmatism, or higher-order aberrations did not change systematically with accommodative demand in Crystalens eyes. As found for paraxial defocus, the effective defocus in Crystalens eyes did not show significant differences between conditions: 0.34 ± 0.48 D (far), 0.32 ± 0.50 D (intermediate), and 0.34 ± 0.44 D (near). Depth of focus was statistically significantly higher in the Crystalens eyes than in the control groups. CONCLUSIONS The accommodative response of eyes implanted with the Crystalens accommodative IOLs, measured objectively using laser ray tracing aberrometry, was lower than 0.4 D in all eyes. Several subjects showed changes in astigmatism, spherical aberration, trefoil, and coma with accommodation, which must arise from geometrical and alignment changes in the lens with accommodative demand. Pseudoaccommodation from increased depth of focus may contribute to near vision functionality in Crystalens-implanted patients.