Accommodative and Dual Optic Intraocular Lenses

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The purpose of this chapter is to provide perspective on intraocular lens technology designed to achieve accommodative function in the pseudophakic state. We briefly introduce the fundamental physiologic optics of accommodation and presbyopia, and then review the achievements and limitations of multifocal intraocular lens technology. We detail the historical development and current status of three single optic accommodative designs, the crystalens, the 1CU and the Tetraflex. Summaries of published and presented clinical studies demonstrate the range of accommodative amplitude expected with each lens, while imaging and biometric data provide conflicting evidence regarding the mechanism of action of these devices. We then examine the Synchrony dual optic accommodative IOL in detail, providing summaries of all available clinical data along with supportive imaging results. In a final section we discuss a couple of novel technologies that lie on the horizon of accommodative IOL implementation, the NuLens and the FluidVision lens.