Incidence and factors for pseudoaccommodation after monofocal lens implantation: the Monofocal Extended Range of Vision study

Abstract

Purpose: To screen the patients with monofocal intraocular lens (IOL) for incidence of unaided 20/40 and J5 for distance and near (pseudoaccommodation) and to find factors for pseudoaccommodation. Settings: University Hospitals Sussex NHS Foundation Trust, UK. Design: Prospective study Methods: This was a single-eye study (Clinicaltrials.gov: NCT04011696). At 3-9 months, refraction, uncorrected & best-corrected distance & uncorrected near LogMAR acuity, spherical equivalent (SEQ), mesopic pupil size (PS), total eye spherical (Z4 0), vertical coma (Z3 -1) aberrations, reading speed and smallest print size were assessed. Refractive astigmatism (RA) was classified as against-the-rule, with-the-rule, oblique and no astigmatism. Data on preoperative axial length (preopAL) and anterior chamber depth (preopACD) were collected. Results: 29 patients (9.6%, 95% CI: 6.5-13.5) had pseudoaccommodation. In cases vs. controls, median SEQ, PS, total Z4 0, Z3 -1, reading speed, smallest print size, preopACD, preopAL were: -0.39 vs. 0.0Diopters; 3.62 vs. 4.10mm; 0.01 vs. 0.02µm; 0.018 vs. 0.022µm; 106 vs. 133wpm (words per minute); 0.30 vs. 0.50LogMAR; 2.94 vs. 3.13mm, 23.4 vs. 23.7mm, respectively. RA was not different between the groups. Univariate analysis revealed preopACD (OR=0.38, 95% CI=0.16-0.94, p=0.04), SEQ (OR=0.61, 95% CI=0.42-0.88, p=0.01), total Z4 0 (OR=0.0003, 95% CI=0.00-0.39, p=0.03) and PS (OR=0.39, 95% CI=0.22-0.69, p<0.041) to be significant. Whereas multivariate logistic regression identified: preopAL (OR=0.62, 95% CI=0.42-0.91, p=0.02), SEQ (OR=0.49, 95% CI=0.31-0.78, p=0.01), Z4 0 (OR=0.00, 95% CI=0.0-0.01, p=0.01) and PS (OR=0.41, 95% CI=0.23-0.75, p=0.01) to be significant. Conclusions: A combination of low myopic SEQ, lower Z4 0, shorter preop AL, and smaller PS increases the chances of pseudoaccommodation.

Reply to the comment on: Incidence and factors for pseudoaccommodation after monofocal lens implantation: the Monofocal Extended Range of Vision study

“…We read with interest the article by Nanavaty et al 1 We had also been noticing just like everybody else that previous to the era of multifocal and trifocal and extended depth-offocus intraocular lenses (IOLs), after implantation of monofocal IOLs, certain eyes somehow attained multifocality, the so-called extended range of vision, and such patients would be extremely satisfied (unpublished data).…”

“…We have always thought and wondered that it would be best to be able to bring about multifocality from naturally occurring principles of physics inside the eye such as those enumerated in the study by Nanavaty et al-low myopic spherical equivalent, lower total eye spherical aberration, shorter preoperative axial length, and smaller pupil size. 1 Perhaps it may be a good idea to mimic and take help of these laws of physics that are going on inside the eye and incorporate into the IOLs.…”

“…Comment on: Association between anterior chamber biometry and posterior capsular defects I read with interest the article by Arad et al regarding the association between anterior chamber biometry and posterior capsular defects. 1 We usually use the numbers…”