Development of a ciliary muscle driven accommodating intraocular lens
Presbyopia still remains the last frontier of refractive surgery.
Its surgical management is under constant evolution due to the limitations that exist today with respect to its management, which is probably in relation with the multifactorial basis in which presbyopia is clinically developed in the human.
Pseudoaccommodation may be accomplished by the induction of certain amounts of higher order aberrations and achromatization, among other less important methods , and they should be studied in lenses wherein real accommodation is the target as it is often masqueraded in the outcomes of AIOLs .
Some of these techniques are based on the adequate performance of the ciliary body using part of the physiological accommodative mechanism, but a surgery for the “real” restoration of accommodation has not yet arrived for clinical practice.
The aging population, especially in western countries, has created millions of candidates around the world for such interventions.
Current non-surgical treatment options include reading spectacles (either mono or varifocal) and contact lenses (either multifocal or monofocal for monovision), but many of these patients, spectacle independent previously, do not easily accept this unavoidable age-related life style change.
While corneal procedures for presbyopia are still under a serious debate regarding their long term outcomes and success rate, current surgical options mostly include refractive lens exchange by either monofocal IOLs for monovision or multifocal IOLs.
In this article, we will update the modern refractive surgeon about the fundamentals and provide updated information about the outcomes of AIOLs by reviewing the concept of accommodation, the different attempts that have been accomplished in the past, their demonstrated published results in human clinical trials, and the future alternatives that may arrive in the near future.
Presbyopia is the physiological degradation of accommodation and still remains as the last frontier of refractive surgery as its surgical management is perhaps the most innovative and challenging and is under constant renewal.