Dynamic imaging of accommodating intraocular lens shift using Optical Coherence Tomography during naturally induced accommodation.

Abstract

Purpose : To assess the dynamic accommodative response of anterior segment structures and accommodating intraocular lenses (IOL) using Spectral-Domain Optical Coherence Tomography (SD-OCT).

Methods : Prospective study performed at Bascom Palmer Eye Institute after approval by the Institutional Review Board of the University of Miami Miller School of Medicine. Four eyes of 3 patients implanted with an accommodative intraocular lens (Crystalens,Bausch & Lomb, Rochester, NY, USA) at least 6 months prior to the imaging session were included in the study after informed consent. The eyes were imaged with a custom-built combined transscleral OCT (wavelength = 1325nm) for imaging of the ciliary muscle and high resolution spectral domain OCT (wavelength =840 nm) for anterior segment and IOL imaging. Images were acquired in a non-accommodated state and during naturally-induced accommodation using a custom made system that provided accommodation /disaccommodation stimuli of 0, 2 and 4 diopters. Measurement of dynamic accommodative response of the IOL axial shift was assessed after semi-automated segmentation.

Results : Mean age of patients was 70.7+/-12.8 ranging from 56 to 85 years old. The mean axial lens shift in response to a 2D accommodation stimulus, calculated as the difference of measurements between the 10 last and 10 first OCT frames, was 26+/-18 microns, ranging from 4 microns to 47 microns. The complete dynamic axial shift of the 4 IOLs is displayed in the Figure: a minimal and very variable axial shift with no consistent trend in the direction of the shift was noticed after a 2D accommodation stimulus. A backward axial lens shift instead of the expected forward shift was recorded in 50% of the cases.

Conclusions : This study enabled the real-time visualization of the axial IOL shift during accommodation. The preliminary results demonstrated that the axial shift of the accommodating IOLs is minimal and cannot provide a good quality accommodative response after naturally induced accommodation.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Dynamic axial shift of accommodating intraocular lens (IOL) in response to a 2D accommodation stimulus in 4 eyes. In the 2 first imaging sessions (IOL#1 and IOL#2), quality of the last 20 OCT scans was not good enough to provide accurate data (the patient blinked).