There is considerable interest in understanding if accommodation can be restored to the presbyopic eye. The first so called accommodative intraocular lens received United States Food and Drug Administration (FDA) approval in November 2003, and FDA clinical trials are currently underway for scleral expansion bands, another other so-called """"""""accommodation restoration"""""""" surgical procedure. Several new, potentially accommodative intraocular lenses are undergoing research and clinical testing and FDA clinical trials are likely to commence for some of these devices within the next two years. Objective accommodation measurement has largely been left to scientists interested in accommodation. Few clinicians use objective means to measure accommodation. No clinical, objective, accommodation testing protocols have been developed, tested or validated for testing pseudophakic eyes. Many commercially available autorefractors, wavefront aberrometers and ocular biometric instruments are on the market and being used in clinical practice, but few if any of these instruments have been systematically tested and validated for objective accommodation measurement. Despite the FDA approval of the first accommodative intraocular lens, it still remains unclear if accommodation is or can be restored with intraocular lenses. This application aims to: (1) design, develop and test clinical accommodation testing protocols using commercially available, objective clinical instruments that can be used in a clinical setting and to test the efficacy of the instrumentation and protocols on normal, young human subjects;(2) test the efficacy of these protocols and instruments in normal, older pre-presbyopic and presbyopic subjects, the target population of accommodation restoration procedures, who have low accommodative amplitudes, to determine the efficacy of the protocol and instrumentation to measure the low accommodative amplitudes expected in this population;(3) to determine the ability of the instruments and the efficacy of the protocols to measure accommodation in pseudophakic eyes and (4) to implement these protocols and instruments in clinical accommodation testing to determine if and how well accommodation restoration procedures such as scleral expansion, radial sclerotomy or accommodative intraocular lenses may restore accommodation in presbyopes. The long term objectives are to validate a commercially available autorefractor, aberrometer and biometry instrument, to demonstrate that accommodation can be measured objectively in clinical settings, to encourage objective accommodation measurement to become widely accepted and implemented in clinical practice and clinical trials to aid in and foster the development of safe and effective accommodation restoration concepts.

Public Health Relevance

A variety of surgical procedures and accommodative intraocular lenses are being developed in an effort to restore active accommodation to the presbyopic eye. Surgical procedures are not without risks. This application proposes the development and testing of objective accommodation measurement protocols in an effort to establish the efficacy of the accommodation restoration surgical procedures so that the benefits can be clearly established to be weighed against the risks.

National Institute of Health (NIH)
National Eye Institute (NEI)
Research Project (R01)
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Special Emphasis Panel (ZRG1-BDCN-F (12))
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Wujek, Jerome R
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University of Houston
Schools of Optometry/Ophthalmol
United States
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Ramasubramanian, Viswanathan; Glasser, Adrian (2016) Predicting Accommodative Response Using Paraxial Schematic Eye Models. Optom Vis Sci 93:692-704
Ramasubramanian, Viswanathan; Glasser, Adrian (2015) Can ultrasound biomicroscopy be used to predict accommodation accurately? J Refract Surg 31:266-73
Ramasubramanian, Viswanathan; Glasser, Adrian (2015) Objective measurement of accommodative biometric changes using ultrasound biomicroscopy. J Cataract Refract Surg 41:511-26
Ramasubramanian, Viswanathan; Glasser, Adrian (2015) Prediction of accommodative optical response in prepresbyopic subjects using ultrasound biomicroscopy. J Cataract Refract Surg 41:964-80
Anderson, Heather A; Manny, Ruth E; Glasser, Adrian et al. (2011) Static and dynamic measurements of accommodation in individuals with down syndrome. Invest Ophthalmol Vis Sci 52:310-7
Anderson, Heather A; Glasser, Adrian; Manny, Ruth E et al. (2010) Age-related changes in accommodative dynamics from preschool to adulthood. Invest Ophthalmol Vis Sci 51:614-22
He, Lin; Donnelly 3rd, William J; Stevenson, Scott B et al. (2010) Saccadic lens instability increases with accommodative stimulus in presbyopes. J Vis 10:14.1-16
Win-Hall, Dorothy M; Houser, Jamie; Glasser, Adrian (2010) Static and dynamic accommodation measured using the WAM-5500 Autorefractor. Optom Vis Sci 87:873-82
Anderson, Heather A; Glasser, Adrian; Stuebing, Karla K et al. (2009) Minus lens stimulated accommodative lag as a function of age. Optom Vis Sci 86:685-94
Win-Hall, Dorothy M; Glasser, Adrian (2009) Objective accommodation measurements in pseudophakic subjects using an autorefractor and an aberrometer. J Cataract Refract Surg 35:282-90

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