gms | German Medical Science

30. Internationaler Kongress der Deutschen Ophthalmochirurgen (DOC)

11.05. - 13.05.2017, Nürnberg

DOC RIDLEY LECTURE: Can accommodation be restored to the presbyopic eye?

Meeting Abstract

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  • Adrian Glasser - Adrian Glasser Consulting Services, LLC, Tampa, USA

30. Internationaler Kongress der Deutschen Ophthalmochirurgen. Nürnberg, 11.-13.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocH 6.5

doi: 10.3205/17doc005, urn:nbn:de:0183-17doc0054

Veröffentlicht: 27. April 2017

© 2017 Glasser.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Purpose: There remains considerable interest in understanding if active accommodation can be restored to the presbyopic eye. Significant efforts over many years have still, so far, failed to bring commercially viable and clinically reliable approaches to routine clinical practice. Many of the challenges are well known, but solutions remain elusive. To successfully restore accommodation requires a sound understanding of the accommodative anatomy and mechanism, the causes of presbyopia and creative ways of solving the remaining challenges.

Methods: The results from prior published studies and publicly available information will be reviewed and discussed.

Results: The basic principles of the accommodative mechanism are well characterized, understood and generally accepted. When the young eye makes an effort to focus at near, the ciliary muscle contracts and releases zonular tension around the lens equator to allow the elastic lens capsule to mould the relatively soft young lens into a more spherical and accommodated form. Further, the basic principles underlying presbyopia are similarly well understood and generally accepted. Lens stiffness increases exponentially with increasing age, and more so in the lens nucleus than in the cortex, due to age-related changes in the lens proteins resulting ultimately in a lens that is unable to undergo accommodative changes in shape. However, the ciliary muscle continues to contract and move with an accommodative effort even in the presbyopic eye. Therefore, if the stiffening of the presbyopic lens can be reversed or if the presbyopic lens can be replaced with an artificial accommodative intraocular lens (A-IOL) capable of undergoing an accommodative change in optical power, it may be possible to restore accommodation to the presbyopic eye. Pharmacological approaches, femtosecond-laser interventions, surgical procedures and A-IOLs are all being investigated. Fundamental physiological challenges such as individual variations in size and shape of the phakic lens, retaining the natural anatomical configuration and viability of the accommodative structures and addressing post-operative changes in the eye still represent the greatest challenges.

Conclusions: There are a number of different approaches aimed at restoring accommodation that are either in early stage development or in human clinical trials, but ultimately the fundamental physiological challenges will need to be addressed for any of these approaches to be successful and to become widely adopted in routine clinical practice.