Functional Assessment of Two Different Accommodative Intraocular Lenses Compared with a Monofocal Intraocular Lens Giorgio Marchini, MD, 1 Paolo Mora, MD, 2 Emilio Pedrotti, MD, 1 Francesca Manzotti, MD, 2 Raffaella Aldigeri, ScD, 2 Stefano A. Gandolfi, MD 2 Purpose: To evaluate selected functional and physical properties of 2 models of accommodative intraocular lenses (IOLs) compared with those of a standard monofocal IOL. Design: Prospective randomized comparative trial. Participants: Subjects were divided into 3 groups. In group 1, 30 eyes (19 subjects) received 1CU IOL implantation; in group 2, 29 eyes (19 subjects) received AT-45 IOL implantation; and in group 3, 21 eyes (21 subjects) were implanted with a monofocal IOL as a control. Intervention: Cataract surgery with implantation of the 1CU and AT-45 accommodative IOL models in the study groups, and the ACR6D monofocal IOL in the control group. Main Outcome Measures: Far and near distance visual parameters were assessed at 1, 6, and 12 months after surgery in the accommodative IOL groups, and at 1 and 12 months in the control group. Anterior segment anatomy was investigated by ultrasound biomicroscopy, with and without visual accommodative stimulation. Results: The accommodative IOL groups significantly differed from the controls in terms of lower near- distance refractive addition (NDRA) and better distance-corrected near visual acuity (DCNVA), with P0.001 at 1 year. The anterior IOL displacement during accommodation (ACD) was significantly larger in the study groups, and this correlated with DCNVA. Until 6 months, the ACD correlated with the solicited sclerociliary process rotation only in the study groups. Conclusion: This 12-month study demonstrated that the accommodating IOLs achieved better clinical results than the monofocal IOL in terms of DCNVA and NDRA. These results support the hypothesis that accommodative IOLs proportionally react to ciliary body rotation, although this relationship became less evident at 12 months. Ophthalmology 2007;114:2038 –2043 © 2007 by the American Academy of Ophthalmology. Current posterior chamber intraocular lenses (IOLs) are biocompatible and achieve very good restoration of far- distance visual acuity. Despite the well-known phenomenon of pseudoaccommodation, the ability of such pseudophakic eyes to focus images at near viewing distances remains poor. 1,2 Multifocal IOLs represent an effective attempt to provide good near and distance vision after cataract extrac- tion. 3 Accommodating IOLs are a further alternative that has recently become available. 4,5 The basic mechanism of these lenses is the transmission, by the haptics, of the contracting forces of the ciliary body to the flexible lens. In near-distance vision, the accommodating IOL plate is sup- posed to move forward toward the cornea, thereby increas- ing the focusing power of the eye. 6 Previous studies have succeeded in demonstrating IOL movements related to cil- iary muscle contraction during accommodation. Both A- and B-ultrasound, dual-beam partial coherence interferom- etry, and other optical devices have been employed to study this. 2,4,6,7 High-frequency ultrasound biomicroscopy (UBM) has proved to be very effective in evaluating several linear and angular parameters of the anterior segment and of the ret- roirideal structures of the eye. 8,9 Thanks to these studies, some data are now available on the correlation between accommodative IOL displacement and accommodative am- plitude (AA). 5 The present study analyzed the in vivo functional prop- erties of 2 different models of accommodating IOLs, the 1CU (HumanOptics, Erlangen, Germany) and the AT-45 Crystalens (Eyeonics Vision, Aliso Viego, CA) models, compared with those of a conventional monofocal IOL. The main parameters considered were the AA, the level of near vision with the best far-distance refractive correction, and Originally received: July 18, 2006. Final revision: December 14, 2006. Accepted: December 17, 2006. Available online: June 6, 2007. Manuscript no. 2006-714. 1 Ophthalmology Institute, University of Verona, Verona, Italy. 2 Ophthalmology Institute, University of Parma, Parma, Italy. Correspondence to Paolo Mora, MD, Institute of Ophthalmology, Univer- sity of Parma, Via Gramsci 14, 43100 Parma, Italy. E-mail: paolo.mora@ unipr.it. 2038 © 2007 by the American Academy of Ophthalmology ISSN 0161-6420/07/$–see front matter Published by Elsevier Inc. doi:10.1016/j.ophtha.2006.12.034