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Sunil Shah, Ajay Pillai, Raquel Gil Cazorla, Shehzad Naroo, Keith H Edwards, Harvey Uy; Presbyopia Reversal: Accommodation Research using Femtosecond Lasers. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4019.
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Restoration of flexibility to the crystalline lens is needed for successful reversal of presbyopia in order to permit sliding of the fibers needed for changes in lens shape during accommodation. The purpose of this study was to determine the effect of in vivo femtosecond lenticular treatments on accommodative amplitude.
Prospective evaluation of 80 patients undergoing cataract surgery who were treated with a range of treatment algorithms. All were <55 years of age with <Grade 2 cataract and agreed to a minimum of 1 month follow-up before lens removal. Patients visual axes were spared in order to limit subjective symptoms. Follow-up visits were at Weeks 1 and 2 and Month 1.
After one week, 33.3% showed an improvement in objective accommodation (measured with Grand Seiko autorefractor) and 53% of subjects showed an improvement in subjective accommodation (push down method). BDCNVA improved in 37.3% of patients at Week 1, improving to 40.8% at Month 1. In patients that showed an increase over baseline, maximum improvement in at Month 1 was 1.5 D and 2.3 D for objective accommodation and subjective accommodation, respectively. Mean improvement in BCDVA in patients with an increase from baseline was 31 letters at Month 1.
In-the-lens treatment can improve objective and subjective accommodation and DCNVA in many patients. Remaining challenges include assessing objective accommodation with comprehensive systems such as aberrometry, the need for improvement in algorithms to increase the percentage of patients benefitting from treatment, and enhancing the improvement in accommodation.
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