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Accommodating IOL Guide

Home / Intraocular Lens (IOL) / Accommodating IOLs

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Eye Lens Replacement Surgery.

Accommodating IOLs (also known as accommodative IOLs) are one of the lens options available to patients undergoing cataract surgery or RLE. The accommodating IOL is a premium option that allows you to see well across different distances by mimicking the natural accommodation process of the eye, with certain limitations.

The IOL you choose will determine your vision outcomes after surgery. Accommodating IOLs can be a great choice for people looking for an IOL that restores a wide range of vision while offering a more natural visual experience.

Table of Contents

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What is Eye Accommodation?

Accommodation is the process that allows a person’s eye to focus at a given distance by altering the shape of the natural lens inside it. There is a muscle in the eye called the ciliary muscle which holds the lens by suspensory ligaments. The contraction or relaxation of the ciliary muscle alters the shape of the lens via the ligaments. Changes of the lens shape are what allow a person to focus on objects near or far.1

Over the course of a person’s life, the hardness or stiffness of the lens increases, greatly impacting its ability to change shape. Around age 40, the lens exhibits a clinically significant reduction in accommodation. This  loss of accommodation as one gets older is the main cause of presbyopia, also known age-related farsightedness. 

How Do Accommodative IOLs Work?

Eye accommodation mechanism
Eye Accommodation: how the eye focuses.

Accommodative IOLs work by mimicking the natural way that the eye moves to adjust focus. These lenses have a unique flexible design that allows them to move in response to the ciliary muscles’ contractions the way the natural lens would.

IOLs are composed of two parts. The main part of the IOL is called the optic. It has a circular shape and its job is to focus light onto the retina. The optic is held in place by “arms” called haptics, which are smaller supporting structures that extend from the optic and keep it stable. Most IOLs have rigid haptics, but those of accommodating IOLs are flexible. When the ciliary muscles contract (for example, when you look at something close), they pull on the haptics  causing the IOL to move and change shape. With this mechanism, accommodating IOLs allow your eyes to focus clearly on objects at different distances.

What Are Accommodating IOLs?

Accommodating IOLs are a premium type of intraocular lenses designed to correct presbyopia by partially restoring eye accommodation. The first accommodating IOL became available after May of 2003, when the Ophthalmic Devices Panel of the Food and Drug Administration (FDA) unanimously recommended approval of the first accommodating intraocular lens model, the CrystaLens.2 A few months after the introduction of the CrystaLens, an astigmatism-correcting version of the same IOL known as Trulign Toric was cleared for market use. Both models are produced and distributed by Bausch + Lomb.

Accommodative Lenses Pros and Cons

Accommodating IOLs provide a good treatment option for people who need a high level of visual performance and prefer a more seamless transition when changing vision focus. Benefits of accommodating IOLs include:

  • Sharper distance vision. Distance visual acuity results with CrystaLens accommodative IOL does not seem to differ significantly from those obtained with monofocal IOLs, which are considered excellent.3 The data to support the approval of this lens found that 100 percent of the subjects that received bilateral CrystaLens implants could achieve near vision measured through the distance correction of 20/40 or better.2
  • Reduced dependence on eyeglasses for reading. A lifestyle survey reviewing the lens found that more than half of the people with this IOL could sit down and read a prescription bottle with 20/25 vision.2 Nearly everybody could read up close with this lens except for very tiny writing or under dim lighting situations.2 
  • Natural vision experience. Because the way they work is shaped after the way the eye functions, accommodating IOLs offer more seamless and familiar vision outcomes.

Accommodating IOLs do have certain limitations and drawbacks. These include:

  • Accommodative IOLs are not covered by insurance. Patients interested in these premium lenses will have to pay additional out-of-pocket expenses.
  •  The accommodative IOLs currently available provide functional presbyopia correction, but cannot restore near vision to the same level of clarity the patient had before developing presbyopia. You may still need reading glasses after surgery, especially small print or reading menus in places situations with very dim lightning, like restaurants
  • The mechanism of accommodating IOLs relies heavily on the proper functioning of the ciliary muscles and the zonules (the fibers that hold the lens in place). If these structures do not work well, the lens may not be able to accommodate properly, limiting its benefits and potentially leading to a situation where it functions more like a monofocal lens, providing good distance vision but poor near vision.

Accommodating IOLs vs Other IOLs

Accommodating IOLs can provide an extended range of clear vision, but they are not the only type of lens with this capability. Make sure to explore your options before committing to any IOL, and discuss any concerns or preferences with your doctor.

Accommodating IOL vs Multifocal IOL

Both accommodating IOLs and Multifocal IOLs provide a wide range of clear vision, but using different mechanisms.

  • Multifocal IOLs provide two or three areas of focus within the same lens by splitting or bending light to create clear images at different distances.
  • Accommodating IOLs have only one focusing in the lens. The accommodating lens moves, allowing variable focusing, including near range.  
  • Because of the way they manipulate light to create multiple focal points, multifocal lenses tend to provide less clarity for distance vision and are more often associated with visual disturbances like  glare and halo.
  • With their single focusing distance, accommodating IOLs offer excellent distance vision, but near vision may not be as clear as the one awarded by multifocal lenses.

Accommodating IOL vs Monofocal IOL

Monofocal IOLs allow the patient to see clearly at only one distance. The distance can be chosen by the patient (e.g. distance, intermediate or near).

  • A traditional monofocal IOL cannot correct both distance and near vision unless monovision is performed. If a patient chooses to have good distance vision, near vision will be blurry and the patient will need reading eyeglasses.
  • An advantage of traditional (or basic) monofocal IOLs is that major insurance plans tend to cover the cost of these lenses. They provide very clear vision and are the oldest and most widely used lens in the market.
  • Accommodating IOLs are considered premium lenses and usually incur additional patient out-of-pocket costs. Accommodating IOLs allow the patient to see from near to far, which makes glasses unnecessary except in very specific situations.

Toric Accommodating IOLs

A traditional monofocal IOL or even an accommodating IOL do not correct for astigmatism, unless the patient chooses a toric IOL. Astigmatism is a type of refractive error (eyeglass prescription) that blurs the vision if not corrected by a toric lens (IOL, eyeglass or contact lens). The toric lens is specially shaped to correct for the visual distortions caused by astigmatism. Currently, the only toric accommodating IOL available is the Trulign Toric from Bausch + Lomb, which is a modified version of the CrystaLens.

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Cost of Accommodative IOL Lens

woman calculating cost

IOLs that are not basic monofocal lenses are considered premium IOLs, and are therefore not covered by insurance. The typical cost for accommodating lenses ranges from $1,200 to $3,500. Because only the CrystaLens (and its toric variant) are available in US markets, patients don’t currently have more affordable alternatives to the same technology. Financing plans are often available to assist in any out-of-pocket expenses related to the cataract surgery. 

FDA Approved Accommodating IOLs & Models in Trial Phase

The only FDA approved IOLs available on the market are the CrystaLens and Trulign Toric from Bausch + Lomb.4 

These current accommodating IOLs provide functional presbyopia correction, but new models are in development to further improve accommodating technology. Some promising accommodating IOLs that are currently in the trial phase include the FluidVision IOL from Alcon, the Lumina IOL from AkkoLens, the Juvene IOL from LensGens and the Omni Vu from Atia Vision.

FluidVision

The FluidVision lens (Alcon, formerly PowerVision) is made of a flexible hydrophobic acrylic shell filled with index-matched silicone oil. A fluid-driven change in the shape of the IOL mimics the natural accommodation of the eye, creating a continuously variable monofocal lens. During accommodation, the capsular bag squeezes the fluid, inflating the lens. In the unaccommodated state, the fluid moves the other way, deflating the lens.6

Lumina

The Lumina (AkkoLens) is a hydrophilic acrylic lens.6 The lens consists of two optical elements that each have an elastic omega-shaped loop.6 When the lens is positioned in the desired position, the ciliary muscle contracts the body of the lens and drives accommodation directly.6 The two optical elements slide and produce a continuous variable-focus lens.6 In the unaccommodated state, the omega-shaped springs of the Lumina are relaxed, the optical elements overlap, and the lens shows its lowest optical power.6 When the eye accommodates, the ciliary muscle contracts and compresses the Lumina.6 The optical power increases linearly with the shift, and the eye focuses at closer distances.6 The size of the Lumina is customized to each eye.6 

Juvene

Juvene (LensGen) is a modular accommodating silicone IOL that is composed of two components—a base lens and a fluid lens. The base lens is inserted first and fixated in the capsular bag. The fluid lens is then inserted and attached to the base lens. The dioptric power (correction for refractive error) of the fluid lens changes in response to compressive forces from the capsular bag on the base lens.6

Opira

Opira (ForSight Vision6) is a dynamic, shape-changing lens made of silicone. This lens allows direct ciliary body engagement without zonular or capsular bag intermediaries. The lens spans from the ciliary body on one side to the ciliary body on the other side. Contraction of the ciliary muscle compresses the peripheral aspect of the lens, which leads to a dynamic change in the shape of the anterior surface, thus changing the power of the IOL.6

OmniVu

The OmniVu (Atia Vision) is a modular accommodative IOL. It consists of a fluid-filled base optic that changes shape and refractive power in response to the contraction of the ciliary muscles and a fixed, exchangeable anterior optic targeting the patient’s refraction.7 In a study involving 25 eyes of 18 patients, vision was stable six months after surgery.7

Accommodating IOL FAQs

Can I get Accommodating IOL after LASIK?

LASIK reshapes the cornea to correct vision, which can alter the eye’s measurements. This makes it more challenging to calculate the correct power for the IOL needed after cataract surgery. For this reason, many surgeons will encourage patients who have had LASIK to choose monofocal IOLs, or the customizable Light Adjustable Lens instead of accommodating or multifocal lenses.

Does an Accommodating IOL Work for Night Driving?

Accommodative IOLs can maintain better contrast sensitivity compared to multifocal lenses, and they also tend to produce less visual disturbances. This makes them a good choice for patients concerned about night driving, as they have been proven to perform well under nighttime lightning conditions. However, any concerns about driving and IOLs should be discussed with your doctor.

Do Accommodative IOLs Last?

Like all IOLs, accommodative IOLs are designed to stay in your eye forever. As with all IOLs, there are rare situations (for example, complications from the surgery) that might necessitate IOL removal, but they are very unlikely.

References

  1. Okpe, O. Accommodation (2023 Mar 08). Retrieved from: Accommodation (eye): anatomy, definition, pathway | Kenhub.
  2. FDA Panel Recommends Approval for First Accommodating IOL (2003 Jul 19). Retrieved from: FDA Panel Recommends Approval for First Accommodating IOL (reviewofophthalmology.com).
  3. Alió JL, Alió Del Barrio JL, Vega-Estrada A. Accommodative Intraocular Lenses: Where are we and Where we are Going. Eye Vis (Lond). 2017 Jun 26;4:16. doi: 10.1186/s40662-017-0077-7. PMID: 28674696; PMCID: PMC5485553.
  4. Kelley, S. Accommodating Intraocular Lenses (IOL) for Cataract Surgery. Retrieved from: https://www.allaboutvision.com/conditions/accommodating-iols.
  5. TerHorst, C. Factors to Consider in Choosing an IOL for Cataract Surgery (2022 Dec 12). Retrieved from Factors to Consider in Choosing an IOL for Cataract Surgery – American Academy of Ophthalmology (aao.org).
  6. Werner, L. Accommodative IOLs: Where are We Now and What’s on the Horizon? (2022 Feb). Retrieved from: crstoday.com/articles/feb-2022/accommodating-iols-where-are-we-now-and-whats-on-the-horizon
  7. Larkin, H. OmniVu Accommodating IOL Moving Forward. (2023 Dec 1). Retrieved from: scrs.org/eurotimes-articles/omnivu-accommodating-iol-moving-forward
  8. Accommodation. American Academy of Ophthalmology.
  9. Accommodative IOLs: Feasible? (September 2018). Ophthalmology Times: Europe.
  10. Accommodative Intraocular Lenses: Where Are We and Where Are We Going? (June 2017). Eye and Vision: BioMed Central.
  11. Axial Movement of the Dual-Optic Accommodating Intraocular Lens for the Correction of Presbyopia: Optical Performance and Clinical Outcomes. (June 2015). Journal of Optometry.
  12. Clinical Application of Accommodating Intraocular Lens. (June 2018). International Journal of Ophthalmology.
  13. IOL Implants: Lens Replacement After Cataracts. (October 2019). American Academy of Ophthalmology.
  14. Multifocal Intraocular Lenses for Cataract Surgery. (November 2019). Verywell Health.

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