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Despite the difficulties in measuring accommodation, accommodative IOLs represent the future in the attempt to successfully “cure” presbyopia.
The restoration of near vision in older individuals that have entered the presbyopic age is considered one of the major challenges in refractive surgery during the last decade.
Due to the high disparity of the methods that are used there is significant inconsistency in the results of many studies [8, 9].
Another source of inconsistency is the fact that several studies in order to evaluate accommodative response of the IOLs use pharmacologic stimulation of accommodation with pilocarpine, or pharmacologic relaxation with cyclopentolate, or both in different time points.
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Even though the lenses mentioned offer satisfactory visual results, contemporary ophthalmology has not completely answered the presbyopic dilemma by simulating the accommodative properties of the crystalline lens itself.
Accommodative IOLs were designed to fill this gap and provide satisfactory vision for all distances by restoring some degree of “pseudoaccommodation.” Pseudo accommodative capability can be linked to monofocal IOL’s as well but the results are not satisfactory enough to fully support unaided near vision.
The function of accommodative IOLs is based on the concept that ciliary muscle movement is supposed to be preserved during presbyopia progression.
There are studies in animal models that show degradation in the ability of the ciliary muscle to offer accommodation with age, but without this being the only reason for the loss in accommodative amplitude .