However, there is not a real change in the IOL power itself.
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This fact made these lenses to be almost abandoned in the last few years, but there are currently other AIOL models being used with innovative mechanisms of action and different anatomical support outside the capsular bag that offer encouraging preliminary results that could bring a new potential of application to these types of lenses.
In this article, we will update the modern refractive surgeon about the fundamentals and provide updated information about the outcomes of AIOLs by reviewing the concept of accommodation, the different attempts that have been accomplished in the past, their demonstrated published results in human clinical trials, and the future alternatives that may arrive in the near future.
It is likely that the ultimate mechanism for presbyopia is a culmination of many factors together resulting in a loss of accommodative amplitude (multifactorial theory).
However, it is unclear if these documented changes in the ciliary muscle and the lens sclerosis occur together or if one is a consequence of the other. Thus, the ideal AIOL would fully resolve the inconvenience of presbyopia and the side effects in relation with current surgical options as the positive visual symptoms or the deterioration of quality of vision after multifocal IOL implantation.
Its surgical management is under constant evolution due to the limitations that exist today with respect to its management, which is probably in relation with the multifactorial basis in which presbyopia is clinically developed in the human.
Until currently, virtually all surgical techniques that have been proposed for its correction are based on the induction of pseudoaccommodation in the presbyopic eye, including multifocality.
When the ciliary muscle constricts, it redistributes its mass like any other muscle and encroaches on the vitreous cavity space, increasing the vitreous cavity pressure, moving the optic forward.
Approximately, 1 mm of movement is equivalent to almost a 2 D power change.
After multiple failures, the question arises if AIOLs replicating the mechanism of accommodation could actually be developed.