Edinger-Westphal and pharmacologically stimulated accommodative refractive changes and lens and ciliary process movements in rhesus monkeys

During accommodation, the refractive changes occur when the ciliary muscle contracts, releasing resting zonular tension and allowing the lens capsule to mold the lens into an accommodated form. This results in centripetal movement of the ciliary processes and lens edge. The goal of this study was to understand the relationship between accommodative refractive changes, ciliary process movements and lens edge movements during Edinger-Westphal (EW) and pharmacologically stimulated accommodation in adolescent rhesus monkeys. Experiments were performed on one eye each of three rhesus monkeys with permanent indwelling electrodes in the EW nucleus of the midbrain. EW stimulated accommodative refractive changes were measured with infrared photorefraction, and ciliary process and lens edge movements were measured with slit-lamp goniovideography on the temporal aspect of the eye. Images were recorded on the nasal aspect for one eye during EW stimulation. Image analysis was performed off-line at 30 Hz to determine refractive changes and ciliary body and lens edge movements during EW stimulated accommodation and after carbachol iontophoresis to determine drug induced accommodative movements. Maximum EW stimulated accommodation was 7.36+/-0.49 D and pharmacologically stimulated accommodation was 14.44+/-1.21 D. During EW stimulated accommodation, the ciliary processes and lens edge moved centripetally linearly by 0.030+/-0.001 mm/D and 0.027+/-0.001 mm/D, with a total movement of 0.219+/-0.034 mm and 0.189+/-0.023 mm, respectively. There was no significant nasal/temporal difference in ciliary process or lens edge movements. 30-40 min after pharmacologically stimulated accommodation, the ciliary processes moved centripetally a total of 0.411+/-0.048 mm, or 0.030+/-0.005 mm/D, and the lens edge moved centripetally 0.258+/-0.014 mm, or 0.019+/-0.003 mm/D. The peaks and valleys of the ciliary processes moved by similar amounts during both supramaximal EW and pharmacologically stimulated accommodation. In conclusion, this study shows, for the first time, that the ciliary processes and lens edge move centripetally, linearly with refraction during EW stimulated accommodation. During pharmacological stimulation, the ciliary processes move to a greater extent than the lens edge, confirming that in adolescent monkeys, lens movement limits the accommodative optical change in the eye.     

The mechanism of accommodation in primates.

OBJECTIVE: To study the accommodative mechanism in primates using monkeys, in light of a recently proposed novel accommodative mechanism in primates and a concomitant controversial surgical procedure for the reversal of presbyopia, DESIGN: Experimental study. METHODS: Accommodation was induced by stimulation of an electrode surgically implanted in the midbrain and by topical ocular application of muscarinic agonists. Pharmacologic disaccommodation was achieved by topical application of a muscarinic antagonist. Movements of the lens equator and the ciliary body were imaged during accommodation and disaccommodation using ultrasound biomicroscopy and goniovideography, and the images were analyzed to determine the direction and the extent of the movements. RESULTS: Despite the systematic eye movements occurring with electrical stimulation and the nonsystematic eye movements occurring with pharmacologic stimulation, in all instances the ciliary body and the lens equator moved away from the sclera during accommodation. CONCLUSIONS: Movement of the accommodative structures is consistent with the classic mechanism of accommodation described by Helmholtz, and contrary to that recently proposed by Schachar.     

Accommodative ciliary body and lens function in rhesus monkeys, I: normal lens, zonule and ciliary process configuration in the iridectomized eye

PURPOSE: The underlying causes of presbyopia, and the functional relationship between the ciliary muscle and lens during aging are unclear. In the current study, these relationships were studied in rhesus monkeys, whose accommodative apparatus and age-related loss of accommodation are similar to those in humans. METHODS: Centripetal ciliary body and lens equator movements were measured during accommodation in 28 eyes of 21 rhesus monkeys (ages, 5.7-26 years) by goniovideography. Ultrasound biomicroscopy was performed in 21 eyes of 17 monkeys. Narrowing of the angle between the anterior aspect of the ciliary body and the inner aspect of the cornea was used as a surrogate indicator of forward ciliary body movement during accommodation. RESULTS: Average centripetal ciliary body movement in older eyes (age > or =17 years, n = 16) was approximately 20% (0.09 mm) less than in young eyes (age, 6-10 years, n = 6), but not enough to explain the 60% (0.21 mm) loss in centripetal lens movement nor the 76% (10.2 D) loss in accommodative amplitude. Average forward ciliary body movement was 67% (49 degrees ) less in older (n = 11) versus young (n = 6) eyes. Maximum accommodative amplitude correlated significantly with the amplitude of centripetal lens movement (0.02 +/- 0.003 mm/D; n = 28; P < 0.001) and with forward ciliary body movement (3.34 +/- 0.54 deg/D; n = 21; P = 0.01). CONCLUSIONS: Decreased lens movement with age could be in part secondary to extralenticular age-related changes, such as loss of ciliary body forward movement. Ciliary body centripetal movement may not be the limiting component in accommodation in the older eye.     

The role of the iris in accommodation of rhesus monkeys

After unilateral total iridectomy, maximum accommodation inducible by corneal iontophoresis of carbachol in rhesus monkeys was approximately 40% less in the iridectomized than in the contralateral untouched eyes, irrespective of age. Ultrasonographically measured anterior chamber shallowing and lens thickening were also less in the iridectomized eyes. Neither submaximal accommodation induced by intramuscular pilocarpine infusion nor maximum accommodation inducible by midbrain stimulation differed in iridectomized and intact eyes. The authors hypothesize that at maximum cholinomimetic drug-induced contraction, the iris sphincter muscle pulls the ciliary body farther forward and inward than does maximum ciliary muscle contraction alone, allowing additional rounding of the lens and, consequently, additional accommodative power.     

Age-related changes in human ciliary muscle and lens: a magnetic resonance imaging study

PURPOSE: To use high-resolution magnetic resonance (MR) images of the eye to directly measure the relationship between ciliary muscle contraction and lens response with advancing age. METHODS: A General Electric, 1.5-Tesla MR imager and a custom-designed eye imaging coil were used to collect high-resolution MR images from 25 subjects, 22 through 83 years of age. A nonmagnetic binocular stimulus apparatus was used to induce both relaxed accommodation (0.1 diopter [D]) and strong accommodative effort (8.0 D). Measurements of the ciliary muscle ring diameter (based on the inner apex), lens equatorial diameter, and lens thickness were derived from the MR images. RESULTS: Muscle contraction is present in all subjects and reduces only slightly with advancing age. A decrease in the diameter of the unaccommodated ciliary muscle ring was highly correlated with advancing age. Lens equatorial diameter does not correlate with age for either accommodative state. Although unaccommodated lens thickness (i.e., lens minor axis length) increases with age, the thickness of the lens under accommodative effort is only modestly age-dependent. CONCLUSIONS: Ciliary muscle contractile activity remains active in all subjects. A decrease in the unaccommodated ciliary muscle diameter, along with the previously noted increase in lens thickness (the "lens paradox"), demonstrates the greatest correlation with advancing age. These results support the theory that presbyopia is actually the loss in ability to disaccommodate due to increases in lens thickness, the inward movement of the ciliary ring, or both.     

Observations on the intraocular changes associated with accommodation: an experimental study using radiographic technique

To visualize the intraocular changes during accommodation, especially in the ciliary body and vitreous, a new radiographic technique was introduced. Radiopaque material, both water-soluble and oily mixture, was injected into the vitreous of the living cat through the sclera beneath the insertion of the superior rectus muscle. An X-ray beam was directed perpendicularly to the axis of the eye, so that the radiographs obtained offered a lateral view of the intraocular structures. The ciliary or superior cervical ganglion was stimulated electrically.During stimulation of the ciliary ganglion, besides the changes in the lens and iris, some movement was observed in the vitreous; this is thought to cause pressure upon the lens at the equator toward the front. The posterior portion of the valley between the ciliary processes also became swollen toward the inner direction of the eyeball. This could account for the relaxation of the zonule attached to the anterior surface of the lens, demonstrating a new function of the cat ciliary body, namely a sphincter-like action.On sympathetic stimulation no change was observed in the lens, the valley between the ciliary processes and the vitreous.     

Enhancing trabecular outflow by disrupting the actin cytoskeleton, increasing uveoscleral outflow with prostaglandins, and understanding the pathophysiology of presbyopia interrogating Mother Nature: asking why, asking how, recognizing the signs, following the trail

Several major areas of work by the author and his international collaborators are reviewed. (1) The ciliary muscle in the non-human primate eye was disinserted at the scleral spur. Pilocarpine was then ineffective in increasing outflow facility, indicating that ciliary muscle contraction mediated the IOP-lowering effect of muscarinic cholinergics. (2) Compounds such as cytochalasins, H-7 and latrunculin A/B, which alter the actin cytoskeleton, cellular contractility and cellular adhesions in cultured trabecular meshwork cells, relaxed trabecular pathway cells and consequently the meshwork itself so as to decrease IOP and enhance trabecular outflow facility in non-human primates. Gene transfer approaches utilizing C3 and caldesmon over-expression by viral vectors to target specific steps in the cellular contractility/cytoskeleton/cell adhesion cascades characteristically altered trabecular meshwork cell morphology and increased outflow facility in organ-cultured anterior segments. (3) Prostaglandin F(2alpha) analogues enhanced matrix metalloproteinase production by ciliary muscle cells and scleral fibroblasts, leading to remodeling of the extracellular matrix of the ciliary muscle and sclera and consequently to increased uveoscleral outflow and decreased IOP in primates. (4) The rhesus monkey was an excellent model for human presbyopia, losing the accommodative response to cholinergic stimulation in the same timeframe relative to lifespan. No changes were found in ciliary muscle enzymes involved in acetylcholine biosynthesis or degradation or in muscarinic receptor numbers or affinity. Contractility of isolated ciliary muscle did not diminish with age, but posterior ciliary muscle attachments stiffened, suggesting a possible role in restricting muscle and consequently lens movement during accommodation. A model to reproducibly stimulate accommodation through central stimulation of the Edinger-Westphal nucleus was developed. Goniovideography and ultrasound biomicroscopic techniques allowed real-time recording and analysis of the accommodation-relevant structures. Surgical ablation of the intraocular structures involved in the accommodation response has led to further understanding of their roles and changes with age related to presbyopia. (5) Global collaborations such as those involved in these studies will be essential in the future, as science becomes "bigger".     

Comparisons between pharmacologically and Edinger-Westphal-stimulated accommodation in rhesus monkeys

PURPOSE: Accommodation results in increased lens thickness and lens surface curvatures. Previous studies suggest that lens biometric accommodative changes are different with pharmacological and voluntary accommodation. In this study, refractive and biometric changes during Edinger-Westphal (EW) and pharmacologically stimulated accommodation in rhesus monkeys were compared. METHODS: Accommodation was stimulated by an indwelling permanent electrode in the EW nucleus of the midbrain in one eye each of four rhesus monkeys. Dynamic refractive changes were measured with infrared photorefraction, and lens biometric changes were measured with high-resolution, continuous A-scan ultrasonography for increasing stimulus current amplitudes, including supramaximal current amplitudes. Accommodation was then stimulated pharmacologically and biometry was measured continuously for 30 minutes. RESULTS: During EW-stimulated accommodation, lens surfaces move linearly with refraction, with an increase in lens thickness of 0.06 mm/D, an anterior movement of the anterior lens surface of 0.04 mm/D, and a posterior movement of the posterior lens surface of 0.02 mm/D. Peak velocity of accommodation (diopters per second) and lens thickness (in millimeters per second) increased with supramaximal stimulus currents, but without further increase in amplitude or total lens thickness. After carbachol stimulation, there was initially an anterior movement of the anterior lens surface and a posterior movement of the posterior lens surface; but by 30 minutes, there was an overall anterior shift of the lens. CONCLUSIONS: Ocular biometric changes differ with EW and pharmacological stimulation of accommodation. Pharmacological stimulation results in a greater increase in lens thickness, an overall forward movement of the lens and a greater change in dioptric power.     

Simultaneous measurements of refraction and A-scan biometry during accommodation in humans.

PURPOSE: Accommodation is a dioptric change in power of the crystalline lens resulting from ciliary muscle contraction that leads to an increase in lens surface curvatures and thickness and changes in the position of lens surfaces. Previous studies have used A-scan ultrasound to measure changes in the position of lens surfaces with voluntary accommodation, but have not simultaneously measured the change in refraction. The goal of this study is to simultaneously measure and correlate refractive and biometric changes in the lens during voluntary accommodation in humans. METHODS: Refraction was measured off-axis in the right eye and biometry on-axis in the left eye simultaneously during voluntary accommodation in 22 human subjects between the ages of 21 and 30 years (mean +/- standard deviation: 25.8 +/- 2.3 years). Subjects viewed a distant target and four near targets spanning the full accommodative range available to evaluate refraction and lens surface position at each accommodative state. RESULTS: Maximum objectively measured accommodative amplitude of all subjects was 5.64 +/- 0.21 D (mean +/- standard error of mean). Biometric and refractive changes during accommodation were linearly correlated. The mean +/- standard error of mean decrease in anterior chamber depth was 0.051 +/- 0.008 mm/D, increase in lens thickness was 0.067 +/- 0.008 mm/D, and increase in anterior segment length was 0.017 +/- 0.005 mm/D during accommodation. There was a net anterior movement of the lens center of 0.017 +/- 0.005 mm/D. CONCLUSION: Anterior chamber depth, lens thickness, and anterior segment length change linearly with refraction during accommodation. Per-diopter changes in the lens were greater in the current study compared with previous studies in which only accommodative demand was measured, which overestimates the accommodative response.     

Comparison of pilocarpine-induced and stimulus-driven accommodation in phakic eyes

With the recent introduction of potentially accommodative intraocular lenses (IOL), there is a need for methods to evaluate their accommodative potential. In most studies assessing IOL movement, pilocarpine is used to stimulate contraction of the ciliary muscle. The aim of this study is to determine if pilocarpine-induced ciliary muscle contraction is comparable to physiological stimulus-driven accommodation in young and presbyopic subjects. Ten emmetropic young subjects (23-25 years) and 11 emmetropic presbyopic subjects (51-62 years) were included in this study. Anterior chamber depth (ACD) and lens thickness (LT) were assessed with partial coherence interferometry (PCI). A moveable stimulus was coupled to the PCI equipment for measurement of biometric lens changes. ACD was measured with the stimulus at infinity and then at the subjects individual nearpoint, and after application of two drops of 2% pilocarpine. In young subjects, there was no significant difference in lens change between nearpoint and pilocarpine stimulation. Presbyopic subjects showed no relevant lens change when accommodating at the nearpoint, however, under pharmacologically induced ciliary muscle contraction with pilocarpine, there was a significant forward shift of the anterior and posterior lens pole, leading to a translational forward lens shift of about 150 microm. This study demonstrates that pilocarpine acts "physiologically" in young phakic subjects, but is a "superstimulus" in presbyopic phakic subjects. Therefore, IOL movement may be overestimated when using pilocarpine to stimulate accommodation.     

Immunohistochemical study of the extracellular matrices related to accommodation in monkeys

PURPOSE: The mechanism of accommodation was studied by immunohistochemical staining of extracellular matrices in monkey eyes. METHODS: Frozen sections from five pairs of post-mortem eyes donated by physiologists were used. The antigens listed in Table 1 were selected, and a 2- or 3-step staining technique was used. Confocal laser microscopy was used to evaluate the staining and take photographs. Many frames were reconstituted for the Figures. RESULTS: a) The ciliary muscle was divided into circular and longitudinal portions by arrangement of alpha-smooth muscle actin and surrounded by dense nets of alpha-elastin at the inner border under pigmented ciliary epithelium. Elastin nets extended into the stroma of the ciliary processes. In the lens, elastin was observed in the equatorial and central subcapsular area. b) Zonules were heavily stained by fibrillin-1 as bundles. Continuous fibers connected the surface of ciliary processes with the lens capsule, and were also anchored along the ciliary epithelium toward the pars plana. Type IV collagen was seen in circumferential lens capsule and between the lens fibers, especially in the equator and central cortex. c) There was more alpha-1A adrenoceptor in the longitudinal than the circular portion of the ciliary muscle. CONCLUSION: Our results provide an argument against Helmholtz's theory, but in favor of Tsherning's theory. The accommodation to near might be accomplished by contraction of circular ciliary muscle held by elastin nets pulling the zonules centripetally. The zonular tension puts pressure on the equator and also pulls the lens capsule anterocentrally. This coordination of the matrices will shorten the equatorial plane of the lens and expand the inter-lens-fiber space, making the polar axis wider. As to the far accommodation, longitudinal muscle will pull the zonules peripherally, narrowing the inter-fiber space.     

The effect of cataract extraction on the contractility of ciliary muscle

PURPOSE: To evaluate the changes in the pilocarpine-induced contractility of the ciliary muscle in eyes with presbyopia before and after cataract extraction using ultrasound biomicroscopy (UBM). DESIGN: Prospective interventional case series. METHODS: A clear corneal phacoemulsification and posterior chamber intraocular lens (AcrySof SA60AT; Alcon Laboratories, Fort Worth, Texas, USA) was implanted in 23 eyes in 15 subjects. UBM was performed with and without instilling 2% pilocarpine, as well as before and two months after cataract extraction. The mean (+/- standard deviation) age was 65.33 +/- 6.09 years (range, 56 to 75 years). The increase in the axial length of the ciliary body (CBAXL) was used as a surrogate indicator of the centripetal ciliary muscle contraction during accommodation. Images of the ciliary body were compared visually using Adobe Photoshop 7.0 (Adobe Systems Inc., San Jose, California, USA). RESULTS: The CBAXL value with and without pilocarpine before cataract extraction was 1.708 +/- 0.165 mm and 1.689 +/- 0.187 mm, respectively, which was not significantly different (P = .261). The CBAXL value with and without pilocarpine after cataract extraction was 1.998 +/- 0.375 mm and 1.675 +/- 0.279 mm, respectively, which was significantly different (P < .001). The visually compared configurations of the changes in the ciliary body were compatible with the analysis of the measured parameters. CONCLUSIONS: Pilocarpine induced only subtle movement of the ciliary body before cataract surgery. However, after cataract extraction, it induced significant centripetal movement of the ciliary body compared with that without pilocarpine. This shows that a lenticular sclerotic component may influence both lens movement and the contractility of the ciliary muscle, and is believed to be related to the presbyopia.     

Magnetic resonance imaging of aging, accommodating, phakic, and pseudophakic ciliary muscle diameters

PURPOSE: To quantify in vivo accommodative changes in the aging human ciliary muscle diameter in phakic and pseudophakic eyes. SETTING: Department of Surgery/Bioengineering, UMDNJ-Robert Wood Johnson Medical School, Piscataway, and the Institute of Ophthalmology and Visual Science UMDNJ-New Jersey Medical School, Newark, New Jersey, USA. METHODS: Images were acquired from 48 eyes of 40 people between the ages of 22 and 91 years, 1 eye of 32 phakic volunteers and both eyes of 8 patients who had monocular implantation of a single-piece AcrySof intraocular lens (IOL) (Alcon Laboratories). Images were acquired during physiological accommodation and with accommodation at rest, and the diameter of the ciliary muscle ring was measured. RESULTS: Results show the ciliary muscle remains active throughout life. The accommodative change in its diameter (mean 0.64 mm) (P<.00001) was undiminished by age or IOL implantation. Preliminary data showed that the accommodative decrease in muscle diameter in phakic and pseudophakic eyes was statistically identical. The phakic eyes had a marked decrease in ciliary muscle diameter with advancing age for both accommodative states (P<.000001 and P<.000001), which did not appear to be altered by IOL implantation. The lens equator was constant with age in the unaccommodated human eye, resulting in decreased circumlental space with advancing age in the phakic eyes. CONCLUSION: Although the undiminished ability of the ciliary muscle to decrease its diameter with accommodation can be relied on in strategies for presbyopia correction, even in advanced presbyopia, the decreasing circumlental space and its potential effects on zonular tension must also be considered.     

Lenticular accommodation in relation to ametropia: the chick model

Our goal was to determine whether experimentally induced ametropias have an effect on lenticular accommodation and spherical aberration. Form-deprivation myopia and hyperopia were induced in one eye of hatchling chicks by application of a translucent goggle and +15 D lens, respectively. After 7 days, eyes were enucleated and lenses were optically scanned prior to accommodation, during accommodation, and after accommodation. Accommodation was induced by electrical stimulation of the ciliary nerve. Lenticular focal lengths for form-deprived eyes were significantly shorter than for their controls and accommodation-associated changes in focal length were significantly smaller in myopic eyes compared to their controls. For eyes imposed with +15 D blur, focal lengths were longer than those for their controls and accommodative changes were greater. Spherical aberration of the lens increased with accommodation in both form-deprived and lens-treated birds, but induction of ametropia had no effect on lenticular spherical aberration in general. Nonmonotonicity from lenticular spherical aberration increased during accommodation but effects of refractive error were equivocal. The crystalline lens contributes to refractive error changes of the eye both in the case of myopia and hyperopia. These changes are likely attributable to global changes in the size and shape of the eye.     

Monitoring accommodative ciliary muscle function using three-dimensional ultrasound

BACKGROUND: Our objective was to develop a three-dimensional high-resolution ultrasonic imaging technique to be utilized for in-vivo characterization of the ciliary body and the posterior iris. The benefit of this imaging in enhancing the quantification of the configurational changes in the ciliary body during accommodation is demonstrated. METHODS: Sequential ultrasound biomicroscopic images of the ciliary body region were obtained with a computer-controlled scanning device designed for use with a standard ultrasound biomicroscope for 3D imaging. Custom-made software allows online data collection, data analysis and 3D reconstruction in conjunction with commercially available VoxelView software. RESULTS: The three-dimensional presentation allows a close approximation of the ciliary muscle inside the ciliary body in vivo. We are able to distinguish and to analyze the changes in the muscle contour in different accommodation states. During accommodation a shift in the ciliary muscle center of gravity in a range of 0.04-0.26 mm (mean 0.13+/-0.06 mm) in the direction of the lens equator, with an interindividual variation and a small decrease with age, was observed. CONCLUSIONS: High-resolution ultrasound is a well established technique for in-vivo investigation of the anterior segment. Three-dimensional ultrasound biomicroscopy allows an assessment of the individual ciliary muscle activity in consideration of the ciliary processes. In combination with a contour analysis tool we improved the muscle contour determination during different accommodation states. The investigation showed an activity of the ciliary muscle in young volunteers as well as those of presbyopic age.     

Accommodation and presbyopia : part 1: physiology of accommodation and development of presbyopia

Accommodation is a dynamic change in the dioptric power of the eye. According to the widely accepted and experimentally confirmed theory of Helmholtz, it is achieved by release of zonular tension with contraction of the ciliary muscle and consecutive modelling of the shape of the crystalline lens by the elastic lens capsule. The ability to accommodate is gradually lost with age (presbyopia). Because of difficulties in examining the accommodative apparatus in vivo, many theories, in part contradictory, about the mechanism of accommodation and the origin of presbyopia have been developed. In recent years experimental studies have greatly increased the knowledge about the acommodative apparatus and suggest a multifactorial aetiology of presbyopia. A better understanding of the physiology of accommodation and presbyopia can contribute to the development of effective treatments.     

Akkommodation und Presbyopie

Accommodation is a dynamic change in the dioptric power of the eye. According to the widely accepted and experimentally confirmed theory of Helmholtz, it is achieved by release of zonular tension with contraction of the ciliary muscle and consecutive modelling of the shape of the crystalline lens by the elastic lens capsule. The ability to accommodate is gradually lost with age (presbyopia). Because of difficulties in examining the accommodative apparatus in vivo, many theories, in part contradictory, about the mechanism of accommodation and the origin of presbyopia have been developed. In recent years experimental studies have greatly increased the knowledge about the acommodative apparatus and suggest a multifactorial aetiology of presbyopia. A better understanding of the physiology of accommodation and presbyopia can contribute to the development of effective treatments.     

Histochemical differences within the ciliary muscle and its function in accommodation

During accommodation, the ciliary muscle is known to move forward-inward. This movement depends on the stiffness of the ciliary muscle connections with the scleral spur. These connections are mediated by the tips of the meridional muscle. If the tips are weakened by pharmacological or surgical means, accommodation suffers. For normal accommodation, it is therefore necessary that the tips stiffen before the contraction of the main part of the muscle. We have therefore looked at the primate eye for enzymatic and ultrastructural differences between the tips and the bulk of the muscle viz, the reticular and circular portion. Myosin ATPase was stained after either alkaline or acid preincubation. Lactate dehydrogenase (LDH), succinic dehydrogenase (SDH), NADH-tetrazoliumreductase (TR) and lipids were stained using conventional methods. The results of the enzyme staining were a modest difference between the meridional tips and the bulk. The tips stained stronger for ATPase following both preincubation methods, and for LDH, whereas the bulk cells stained stronger for SDH, NADH-TR and lipids. The tips contained fewer mitochondria and more myofibrils. In all these respects, the tips of the meridional muscle resemble the fast fibers of striated muscle.     

Evaluation of Verisyse and Artiflex phakic intraocular lenses during accommodation using Visante optical coherence tomography

PURPOSE: To perform a dynamic study of the relationship between Verisyse (AMO) and Artiflex (Ophtec B.V.) phakic intraocular lenses (pIOLs) and anterior chamber structures during accommodation using optical coherence tomography (OCT) (Visante, Carl Zeiss Meditec, Inc.) SETTING: Institutional practice. METHODS: Eleven myopic patients were randomly selected to have implantation of a Verisyse pIOL in 1 eye and an Artiflex pIOL in the other. Using a 2-dimensional image, dynamic measurements of the relationship between the anterior surface of the pIOL and the corneal endothelium, the posterior surface of the pIOL and the anterior surface of the crystalline lens, and the pupil diameter were performed using Visante OCT. Physiological accommodation was stimulated by adding lenses in 1.00 diopter (D) steps from +1.00 to -7.00 D. RESULTS: Both groups had a significant decrease in pupil diameter (P<.0001, generalized linear model [GLM]) and in the distance between the anterior surface of the pIOL and the corneal endothelium (P<.0001, GLM) with accommodation. There were no statistically significant changes in the distance between the posterior surface of either pIOL and the anterior surface of the crystalline lens (P = .2845, GLM). There were no statistically significant differences between the 2 pIOLs in any measurement (P>.05, GLM). CONCLUSIONS: The results fit with Helmholtz' theory of accommodation as forward movement of the diaphragm iris-crystalline lens was seen. There was a decrease in the distance between the pIOL and corneal endothelium and in the pupil diameter, whereas the distance between both pIOLs and the crystalline lens remained constant throughout the accommodation examination. This suggests that the risk for cataract from intermittent contact between the crystalline lens and IOL from accommodative effort is unlikely.     

Age-related behavior of posterior chamber lenses in myopic phakic eyes during accommodation measured by anterior segment partial coherence interferometry

PURPOSE: To evaluate age-related position shifts of the crystalline lens and the implantable contact lens (ICL, Staar Surgical) by a new, commercially available, anterior segment partial coherence interferometer, the ACMaster (Carl Zeiss Meditec), during accommodation in myopic eyes. SETTING: ALZ Augenklinik, Munich, Germany. METHODS: Fifty-three eyes of 29 consecutive patients were measured after myopic ICL implantation before and during subjective accommodation to a stimulus of 3 diopters (D) by anterior segment partial coherence interferometry (PCI). Nine eyes were also measured with a 5.00 diopters (D) stimulus; 14 eyes were measured repeatedly at different visits. The mean patient age was 33 years +/- 9 (SD) (range 21 to 59 years). The preoperative mean sphere was -7.6 +/- 1.9 D (range -5.0 to -11.5 D) and the cylinder, -1.4 +/- 1.1 D (range 0 to -4.25 D). RESULTS: Older patients had a tendency toward smaller vaults on desaccommodation between the ICL and the crystalline lens compared to younger individuals. In younger patients, there was a decrease of the vault on accommodation, whereas it increased in older persons (P = .005). During accommodation, the more the anterior lens surface shifted forward, the more the ICL bulged (P = .005). The change in vaulting was significantly larger at 5.00 D than at 3.00 D accommodation stimulus (P = .012). CONCLUSIONS: The behavior of ICLs in relation to the crystalline lens during accommodation varied with age and could be shown by PCI. The position shift of the ICL depended on the initial vault at desaccommodation and the ability of the anterior lens surface to bulge forward. Even though the crystalline lens stiffened, and therefore accommodation deteriorated with age, there was still a movement of the ICL, pointing to the role of the ciliary muscle movement in accommodation.