Ray-tracing Analysis of Accommodation and Pseudoaccommodation in Phakic and Pseudophakic Eyes

Abstract

PURPOSE: To compare objective measurements of accommodation and pseudoaccommodation in phakic and pseudo-phakic eyes using ray-tracing aberrometry. METHODS: Patients with normal and hyperprolate corneas (post-hyperopic laser in situ keratomileusis) who underwent cataract surgery from March 2018 to October 2019 at the Medical University of South Carolina were examined and received either a diffractive intraocular lens (IOL) with an echelette design (Tecnis ZXR00 Symfony; Johnson & Johnson Vision), a monofocal IOL with negative spherical aberration (Tecnis ZCB00; Johnson & Johnson Vision), or an aberration-free IOL (MX60E; Bausch & Lomb). The control groups consisted of young and presbyopic phakic patients. Ray-tracing wavefront analysis was performed 1 to 3 months postoperatively. Objective ray-tracing metrics of accommodation and pseudoaccommodation included the effective range of focus, sphere shift accommodation, and depth of focus. RESULTS: Sixty-two eyes received a Tecnis ZCB00, 39 a MX60E, and 43 a Tecnic ZXR00 Symfony IOL; furthermore, 20 young phakic eyes and 19 presbyopic eyes were included in this study. The effective range of focus and sphere shift accommodation in the young control group were statistically larger than in the presbyopic group ( P = .005 and P < .001, respectively). There was no difference in effective range of focus, sphere shift accommodation, and pseudoaccommodations between the different IOL groups. The young control group had the highest visual Strehl optical transfer function for near and distant targets (0.64 ± 0.24 and 0.56 ± 0.19, respectively), whereas the aberration-free IOL in the MX60E hyperprolate cornea group presented the lowest visual Strehl optical transfer function value for near (0.49 ± 0.19). CONCLUSIONS: Ray-tracing aberrometry can objectively assess accommodative amplitude in phakic eyes and pseudoaccommodation (depth of focus) in pseudophakic eyes. [ J Refract Surg . 2022;38(10):661–667.]