Transcript 13 YO Accommodative Test Tracey Wavefront Comparison

Accommodative Arching
Eyeonics Briefing
2 February 2005
Kevin L. Waltz, OD, MD
Eye Surgeons of Indiana
Indianapolis, IN
Outline of Briefing
Background
Measurement limitations
Historical assumptions
Fortuitous patient
Archeological evidence
Theory fit with known data
Background for AA Theory
KLW’s interest in refractive lens surgery
Tracey experience since summer 2002
i Trace experience since fall 2003
Experience with capsular effects on IOL’s
KLW’s frustration with initial AT-45 outcomes
Extensive wavefront testing of distance and
near vision with IOL’s, including AT-45 pts
Array Eye for Tracey Review
Experience with Capsular/YAG Effects
on Multifocal Optics
Pre-YAG
20/20 & J3
10 minutes
Post-YAG
20/20 & J1
Experience with Monofocal IOL’s
“Pseuodaccommodation”
Measurement Limitations
Original Tracey 64 sequential spots
i Trace sequential 256 spots
Variable spot positioning on Tracey
Tracey can readily measure wavefront at near
Shack-Hartmann simultaneous spots
NIPEK OPD simultaneous topo and wavefront
COAS direct imaging
Historical Assumptions
Near wavefront ignored
Near wavefront assumed to be the same
as distance with some amount of
uniformly increased power
Reading glasses = accommodation
Low HOA @ distance = low HOA @ near
Low HOA @ near is good
Zachary Waltz 13 yo
OD – No accommodation
OD – 5 D accommodation
Successful College Student 19yo
OS – No accommodation
OS – 5 D accommodation
Successful Medical Student
S/P LASIK 23 yo
OD – No accommodation
OD – 5 D accommodation
Fortuitous Patient
72 year old white male cataract pt
Desired to be less dependent on glasses
Uneventful cataract surgery
PO: Little to no near vision and myopic
Repositioned IOL in bag at 7 weeks to
decrease myopia, rotated IOL 90°
Improved distance and near vision
Prior to IOL Rotation
Accommodation with Crystalens
S/P IOL Rotation by 90°
Distance refractive map
Near refractive map
0.186 rms total error
0.464 rms total errror
0.69+0.36X078
-2.37+0.92x008
Crystalens Accommodative Arching
AA at a Different Meridian 8:46
AA at a Different Meridian 8:47
AA Relaxed 8:52
AA relaxed 8:53
AA at Maximum 10 Diopters 8:54
Archeologiccal Evidence
“The aberrations in some Tracey images are not
compatible with high quality vision.”
Archeologiccal Evidence
Archeologiccal Evidence
46 yo Optometrist
Phakic Patients have AA
33 yo WF Preop Cataract
50 yo Optometrist Preop Cataract
17 yo Son of Optometrist
17 yo w/ 5 Diopters Stimulus
& 3.25 Diopters AA Response
50 yo Optometrist Dilated PO #1
50 yo Optometrist Dilated PO Week 3
48 yo Prelex Preop Distance
48 yo Prelex Preop Near
1.25 Diopters of “Accommodation”
AA Theory Fit With Known Data
Images are almost certainly real
Axial movement of 0.3 mm needed for
10 D of AA flexing over 2mm diameter
Variations in Crystalens orientation
relative to power axis in eye would
create inconsistent measured near
vision in patients
Capsule effects might change with
time
AA Theory Fit With Known Data
Variations in IOL power with AA and
emerging concept of neuroplasticity
could explain inconsistency in
measured accommodation
vs
observed near vision