Accommodative and Multifocal IOLs

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Accommodative and Multifocal IOLs
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How the eye works

• Light rays enter the eye through the clear
  cornea, pupil and lens.
• These light rays are focused directly onto the
  retina, the light-sensitive tissue lining the
  back of the eye.
• The retina converts light rays into impulses,
  sent through the optic nerve to your brain, where
  they are recognized as images.
• 70 of the eye's focusing power comes from the
  cornea and 30 from the lens.

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Refractive errors

• Inability to see clearly is often caused by
  refractive error.
• Four types of refractive error
• Myopia (nearsightedness)
• Hyperopia (farsightedness)
• Astigmatism
• Presbyopia

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Refractive errors myopia

• In myopia (nearsightedness), there is too much
  optical power in the eye
• The distance between the cornea and the retina
  may be too long or the power of the cornea and
  the lens may be too strong.
• Light rays focus in front of the retina instead
  of on it.
• Close objects will look clear, but distant
  objects will appear blurred.

Myopia, or nearsightedness
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Refractive errors hyperopia

• In hyperopia (farsightedness), there is too
  little optical power.
• The distance between the cornea and the retina
  may be too short.
• Light rays are focused behind the retina instead
  of on it.
• In adults (but not children), distant objects
  will look clear, but close objects will appear
  blurred.

Hyperopia, or farsightedness
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Refractive errors astigmatism

• In astigmatism, the cornea is curved
  unevenlyshaped more like a football than a
  basketball.
• Light passing through the uneven cornea is
  focused in two or more locations.
• Distant and close objects may appear blurry.

Astigmatism occurs when light passes through
football-shaped cornea and/or lens
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Refractive errors presbyopia

• Presbyopia is an age-related condition in which
  your eyes gradually lose the ability to see
  things up close, because the lens of the aging
  eye can no longer change shape.
• When we are young, the lens in our eyes is
  flexible and is able to change focus easily
  between near and far objects, like an autofocus
  on a camera.
• At around age 40, this flexibility begins to
  gradually decrease, making it more difficult to
  see objects up close, unless the eye has
  nearsightedness.

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What is accommodation?

• The eyes lens, which provides your focusing
  power, has four primary functions
• Transparency To provide a clear medium through
  which light rays from an object can reach your
  retina.
• Optical To focus a sharp image of an object on
  the retina.
• Anatomic To create a functional barrier between
  the anterior and posterior segments of the eye.
• Accommodation To vary the eyes refractive
  power, thus providing clear images of objects
  over a wide range of distances.

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What is refractive surgery?

• A group of outpatient surgical procedures used to
  alter how your eye focuses light rays on the
  retina, thereby improving vision and reducing
  dependence on glasses and contact lenses.
• In most cases, refractive surgery affects the
  shape of your cornea to redirect how light is
  focused onto the retina. Popular procedures
  include LASIK, LASEK, PRK and CK.

Refractive surgery procedure on the cornea
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What is refractive surgery?

• Most refractive surgery is performed on the
  cornea and affects only the front of your eye,
  while the rest of your eye will change naturally
  as you age.
• In some cases, refractive surgery procedures
  dont reshape the cornea instead, the eyes
  natural lens is either replaced or enhanced by an
  implantable lens that helps correct vision.

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What are accommodative intraocular lenses (IOLs)
and multifocal intraocular lenses (IOLs)?

• An artificial lens that is surgically implanted
  in the eye, replacing the eyes natural lens.
• Enables your eye to regain its focusing and
  refractive ability.
• The cornea is not reshaped.
• Used to treat nearsightedness (myopia),
  farsightedness (hyperopia) and the inability to
  focus at near with age (presbyopia).

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What is an accommodative intraocular lens (IOL)?

• The accommodative IOL is hinged to work in
  coordination with the eye muscles.
• The design allows the accommodative lens to move
  forward as the eye focuses on near objects, and
  move backward as it focuses on distant objects.

A type of accommodative intraocular lens (IOL)
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What is a multifocal IOL?

• A multifocal lens has several rings of different
  powers built into the lens.
• The part of the lens (ring) you look through will
  determine if you see clearly at a far, near or
  intermediate distance (this is sometimes called
  pseudo-accommodation).

A type of multifocal intraocular lens (IOL)
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How is the IOL procedure performed?

• The IOL is implanted in a surgical procedure,
  performed on an outpatient basis under local
  anesthesia and taking approximately 20-30
  minutes.

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How is the IOL procedure performed?

• In addition to a pre-operative eye exam,
  measurements of the eye are taken to give the
  surgeon the necessary information to perform the
  procedure. These measurements include
• Refractive error measurement.
• Pupil evaluation and size measurement.
• Keratometry measurement of the form and
  curvature of the cornea.
• A-scan Measurement of the axial length of the
  eye from the cornea to the retina.
• Calculations to determine the correct power of
  lens (IOL) to use.

A phoropter is used to measure refractive errors
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How is the IOL procedure performed?

• After the eye is numbed with topical or local
  anesthesia, one to three small incisions are made
  close to the edge of the cornea.
• After the procedure, these incisions are usually
  self-sealing, requiring no stitches.

Small incisions are made close to the edge of the
cornea for inserting the IOL
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How is the IOL procedure performed?

• A tiny, high-frequency ultrasound instrument is
  inserted into the eye to break up the center of
  the eyes natural, crystalline lens.
• The natural lens is then gently vacuumed out
  through one of the incisions.

The eyes natural lens is suctioned out through
an incision
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How is the IOL procedure performed?

• An IOL is folded and inserted through the same
  incision that was used to extract the natural
  lens.
• The IOL is then unfolded and placed into the
  "capsular bag" that originally surrounded the
  natural lens.

IOL in the eye
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How is the IOL procedure performed?

• Once the accommodative or multifocal IOL is
  implanted, your eye can focus on near,
  intermediate and far distances.

The IOL firmly in place
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Considerations for the accommodative/multifocal
IOL procedure

• May be an option for people with cataracts or
  people without cataracts who are presbyopic and
  want to reduce or eliminate their need for
  glasses.

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Considerations against the accommodative/multifoca
l IOL procedure

• The focusing ability of the lens may not be fully
  realized for six to eight weeks after the
  procedure.
• Your eye must re-learn how to focus on objects at
  various distances in order to see clearly.

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Risks and possible side effects of
accommodative/multifocal IOL surgery

• Over-correction or under-correction (with a
  possible need for a re-treatment).
• Infection.
• Increased floaters or retinal detachment.
• Dislocation of implant.
• Loss of vision.

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Is refractive surgery right for you?

• Advanced surgical procedures, including
  accommodative and multifocal IOLs, are creating
  more opportunities for people who want to be less
  dependent on glasses or contacts.
• Surgery may not entirely eliminate your need for
  corrective lenses. Glasses/contacts may still be
  needed for activities such as fine or detailed
  work, reading and perhaps night driving.
• If an accommodating or multifocal IOL is used,
  then reading as well as distance vision may be
  improved.

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Is refractive surgery right for you?

• A large part of the success of any refractive
  surgery depends on your understanding of the
  procedure and your expectations.
• Since refractive surgery is an elective
  procedure, you have the opportunity and
  responsibility to become fully informed about its
  risks and benefits.
• Your ophthalmologist will explain the specific
  technique, its benefits, as well as possible
  risks and side effects associated with your case.

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Discuss options and questions with your
ophthalmologist

• With the help of your ophthalmologist, its
  ultimately your responsibility to weigh the risks
  and side effects of a procedure with the benefits
  it has to offer.
• If you decide refractive surgery is right for
  you, you may join millions of people who have
  reduced their dependence on glasses or contacts.