Accommodation and Presbyopia

 Hermann von
Helmholtz in 1855.
 Ronald A. Schachar,
MD, in 1994.

Schachar RA, Black TD, Kash RL, Cudmore DP, Schanzlin DJ.
The mechanism of accommodation and presbyopia in the
primate. Ann Ophthalmol. 1995;27:58-67
Surgical Modalities of Treatment
of Presbyopia
1. Anterior Ciliary sclerotomies with silicone
implants.
2. Monovision (LASIK, Conductive keratoplasty,
IOLs).
3. Multifocality (LASIK, Phakic IOLs or pseudophakic
IOLs)
4. Accommodating IOLs (Crystalens or 1-CU)
 Crystalens

 Third-generation non-
reflective silicone material
(Biosil).
 High refractive index (RI
= 1.430).
 Contains an ultraviolet
(UV) filter.
 Hinged adjacent to the
optic and has small looped
polyimide haptics.
 Characteristics of
Crystalens

 The overall length of the lens

is 11.5 mm (loop tip to loop tip
measurement).
 The overall length as
measured from the ends of the
plate haptics is 10.5 mm .
 The optic is biconvex and is
4.5 mm in diameter.
 The A-constant is 119.0.
 Dynamic action
(Focus-Shift Principle)
 Evidence Based Medicine
“An increase in the
vitreous pressure with
simultaneous
decrease in the
anterior chamber
pressure occurred
upon direct
stimulation of ciliary
muscle in ten
primates”.
Coleman J. On the hydraulic suspension theory
of accommodation. Trans Am Ophthalmol Soc.
1986;846-868
 “Evaluation of Crystalens
Accommodating IOL”

Protocol for submission of MD Thesis

Benha Ophthalmology Department
Exclusion criteria:
 Keratometric cylinder more than 1 diopter.
 Bilateral congenital cataract.
 Microphthalmos
 Previous ocular surgery.
 Anterior segment pathology.
 Incomplete or damaged zonules or aniridia.
 Uncontrolled glaucoma or visual field loss
secondary to glaucoma.
 Previous retinal detachment or pathology.
 All phaco cases aimed for
postoperative emmetropia and will
be operated in Ophthalmology
department in Benha University
Hospital and followed up for
6 months.
 Conventional phaco:
 Clear corneal 3.5mm section
(on steepest meridian).
 Small rhexis 4.50 – 5.00 mm.
 IOL should be intrabagal.
 Install Atropine ED.
All the cases will be
implanted with C&C vision
Crystalens IOL (Model
AT-45)
Multi-piece Silicone plate
shaped IOL.
 Assessment of the
Accommodative amplitude

 Subjectively.
 Objectively.
 All these investigations should be
done in all visits:
1mo 3mo 6mo
UCVA for Distance   
Manifest Rx   
BSCVA for Distance   
UCVA for near (40cm)   
VA for near with Distant   
correction (40cm)
Add   
BSCVA for near with Add   
(40cm)
 All these investigations should be
done in all visits:
1mo 3mo 6mo
Axial length + AC depth   

Axial length + AC depth with   

pilocarpine 1%

Slit lamp examination   

 Future
 Split double optics or combine the focus
shift principle with shape change of the
optic.
 Smart lens ?!
Thank you