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INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE / December 1984

Vol. 25

Apparent Accommodation in Pseudophakic Eyes after Implantation of

Posterior Chamber Intraocular Lenses: Optical Analysis
Mirsuru Nokozowo* and Kiyoshi Ohrsukif

The authors measured apparent accommodation in 39 pseudophakic eyes (31 patients) after implantation of posterior
chamber intraocular lenses. The mean apparent accommodation was 2.01 0.95 D. The authors also measured each
patient's pupillary diameter, anterior chamber depth, and
corneal refractive power to calculate the factor that represents the depth of field. The authors found a significant
correlation between apparent accommodation and depth of
field. The correlation between apparent accommodation and
calculated depth of field is statistically significant (r = 0.48,
P < 0.005). Invest Ophthalmol Vis Sci 25:1458-1460, 1984
It long has been acknowledged that some aphakic
patients have good near vision while wearing glasses
with only their distance correction: The phenomenon
has been called apparent accommodation.1"3 We4
previously reported that apparent accommodation
also can be observed in pseudophakic eyes after
implantation of posterior chamber intraocular lenses.
In the previous study,4 we assumed that pupillary
diameter is the major feature responsible for apparent
accommodation, and depth of field. To confirm this
speculation, we studied this relationship mathematically and optically.
Materials and Methods. The amplitude of apparent
accommodation was measured in 39 eyes of 31
patients who underwent cataract extraction and posterior chamber lens (j-loop) implantation in the Tohoku Teishin Hospital between January 1981 and
October 1982. All patients were operated on by one
of us (K.O.). The subjects ranged in age from 42-90
years (mean age: 66 years). The method of measuring
apparent accommodation was the same as previously
described4: The near point for each patient was
measured with the Ishihara near-point meter, and the
far point was calculated from each patient's refraction
as determined by streak retinoscopy. We calculated
the apparent accommodation in diopters in the pseudophakic eyes from the near and far points measured.
All patients had normal ophthalmoscopic findings
and normal responses on scotopic electroretinography.
Scotopic electroretinography Had been performed
preoperatively to eliminate the patients with extensive
retinal disorders. Postoperative visual acuity ranged
from 0.4-1.5, which was sufficient to read the visual
targets of the Ishihara near-point meter.
All patients underwent the following measurements
during a period of three months to one and a half
years postoperatively; pupillary diameter, keratometry,

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and anterior chamber depth. The pupillary diameter

was measured with the Haab pupil meter under a
slit-lamp microscope, which was magnified five times
with constant illumination of 1,700 lux centered on
the corneal surface. Anterior chamber depth was
measured with the Haag-Streit anterior chamber depth
meter. All patients understood the purpose and methods of this study and consented to undergo these
measurements as mentioned above.
Depth of field consists of anterior depth of field
(distance between N and Q in Fig. 1) and posterior
depth of field (distance between Q and M in Fig. 1).
Since the far point calculated from the patient's
refraction coincides with point Q in theory, we dealt
with anterior depth of field in relation to apparent
accommodation. The optical relationship between
anterior depth of field and the optical system of the
eye is shown in Fig. 2. Three following formulas
concerning anterior depth of field can be described
with geometrical optics as
1

f+
1

V
k
a

= PT

(1)

= PT

(2)

fi

where f and fi are the distance from the eye to Q

and N, respectively; f and f{ are the distance from
the eye to Q' and N', which are the conjugate points
of Q and N, respectively; P T is the total refractive
power of the optical system, "a" is the actual optical
aperture, or pupillary diameter in the eye; "k" is the
diameter of the permissible blur circle AB, which is
provided by the depth of focus.
The amount of anterior depth of field in diopters
can be derived from formulas 1-3 as

Formula 4 can be also described as

(5)
where P c is corneal refractive power, P L is the refractive power of the intraocular lens, and "d" is anterior

No. 12

Reporrs

1459

Q1

Fig. 2. Optical relationship between anterior depth of field and

the optical system of the eye. Anterior depth of field is the distance
between Q and N (f - f,) and points Q' and N' are the conjugate
points of Q and N, respectively. Abbreviations represent pupillary
diameter (a), the diameter (AB) of the permissible blur circle (k).
Fig. 1. Schematic drawings of depth of field and depth of focus.
Top, Anterior depth of field (f - f,). Bottom, posterior depth of
field (f2 - f). Abbreviations represent anterior chamber depth (d),
pupillary diameter, (a), and the diameter (AB) of the permissible
blur circle (k).

chamber depth. If k is constant, formula 5 shows

that amplitude of the depth of field (diopter) is in
proportion to - ( P c + P L - d - P c - P L - 7 ) . For
f/
a V
convenience, we used R to represent - I P c + P L

aV
- d P C PL - 7 ) Using R, formula 5 can be described
as
(6)
The actual amount of R was calculated from each
patient's data, as mentioned above. We studied the
relation between apparent accommodation and R,
because R can be considered as representative of the
anterior depth of field. The Student's t-test for statistical studies was used to show the significance
level (/>).
Results. Apparent accommodation in 39 pseudophakic eyes was 2.01 0.95 D. We found a significant
correlation between apparent accommodation and R
(Fig. 3). The correlation coefficient between them was
0.48 and was statistically significant (P < 0.005).
As reported in the previous study,4 we also found
a significant correlation between apparent accommodation and the reciprocal of the pupillary diameter.
The correlation coefficient between them was 0.46
and was also statistically significant (P < 0.005).
Discussion. In the present study, we examined the
relation between apparent accommodation and depth
of field. Although the actual far point coincides point
M and the actual depth of field is composed of both
anterior and posterior depth of field (distance between

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M and N in Fig. 1), it is difficult to measure the

precise distance between point M and the eye clinically. Because the far point employed in this study
was calculated from the patient's refraction determined by streak retinoscopy, it is the same point as
point Q, and we dealt with anterior depth of field in
relation to apparent accommodation. For convenience, we used R to represent anterior depth of
field, because anterior depth of field can be considered
to be in proportion to R. This hypothesis can be
justified when the diameter of the blur circle (k in
Formulas 3-5, AB in Figs. 1, 2) is constant. Although
the actual amount of k cannot be known precisely,
we considered it constant in our patients because
they had neither particular macular disease nor other
retinal degeneration which might affect the resolving
power of the retina.
The result obtained showed that a significant correlation exists between apparent accommodation and
R (Fig. 3); that is, apparent accommodation is almost
proportional to R by regression line analysis, because
0.22 is almost negligible. That apparent accommodation is almost proportional to R suggests that it is
5.0

r = 0.48 (P<0.005)

4.0

Y = 0.076x10"^X + 0.22
3.0
2.0

1.0

10

15

20

25

30

R, rrf2

35

40

45

x10 3
Fig. 3. Apparent accommodation and R in 39 pseudophakic
eyes are significantly correlated (P < 0.005).

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INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE / December 1984

highly related to anterior depth of field, which also is

in proportion to R.
The correlation coefficient between apparent accommodation and R (0.48) was greater than that
between apparent accommodation and the reciprocal
of the pupillary diameter (0.46). That the correlation
obtained by taking five factors into account increases
the significance beyond that obtained with pupillary
diameter alone supports the close relationship between
apparent accommodation and depth of field.
Several authors5"9 have reported apparent accommodation in pseudophakic eyes after implantation
with iris-supported lenses or iridocapsular lenses.
Sugitani and co-workers5 and Huber7"9 have speculated that this phenomenon is related to depth of
focus. Because depth of focus and depth of field are
closely related (Fig. 1), the results obtained from the
present study also support their speculations.
Key words: apparent accommodation, pseudophakic eye,
posterior chamber intraocular lens, depth of field, depth of
focus

Acknowledgments. The authors would like to thank Professor K. Mizuno for his advice and Ms. M. Gere for her
helpful reading of the manuscript.

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Vol. 25

From the Department of Ophthalmology, Tohoku University

School of Medicine,* and the Department of Ophthalmology,
Tohoku Teishin Hospital.f Sendai, Japan. Submitted for publication:
March 19, 1984. Reprint requests: M. Nakazawa, MD, Department
of Ophthalmology, Tohoku University School of Medicine, 1-1
Seiryo-cho, Sendai, Miyagi 980, Japan.

References
1. Zentmayer W: Apparent accommodation in aphakia. Am J
Ophthalmol 3:570, 1918.
2. Horton JJ: Apparent accommodation in the aphakic eye. Am
J Ophthalmol 12:489, 1929.
3. Bettman JW: Apparent accommodation in aphakic eyes. Am
J Ophthalmol 33:921, 1950.
4. Nakazawa M and Ohtsuki K: Apparent accommodation in
pseudophakic eyes after implantation of posterior chamber
intraocular lenses. Am J Ophthalmol 96:435, 1983.
5. Sugitami Y, Komori T, Katoh R, and Hayano S: Apparent
accommodation (pseudoaccommodation) on pseudophakia. (in
Japanese). Folia Ophthalmol Jpn 30:326, 1976.
6. Hoshi H, Kamegasawa A, Chikuda M, Nemoto R, and Imaizumi
S: Visual functions of intraocular lens implanted eye (pseudophakic eye) with special reference to pseudoaccommodation.
(in Japanese) Folia Ophthalmol Jpn 31:1409, 1980.
7. Huber C: Myopic astigmatism as a substitute for accommodation
in pseudophakia. Doc Ophthalmol 52:123, 1981.
8. Huber C: Planned myopic astigmatism as a substitute for
accommodation in pseudophakia. J Am Intraocular Implant
Soc 7:244, 1981.
9. Huber C: Myopic astigmatism as a substitute for accommodation
in pseudophakia. Dev Ophthalmol 5:15, 1981.