Accommodation in phakic and pseudophakic eyes measured with subjective and objective methods

PURPOSE: To measure accommodation subjectively and objectively and assess anterior segment changes during accommodation in phakic eyes and pseudophakic eyes. SETTING: Department of Ophthalmology, Medical Health and Science Centre, University of Debrecen, Debrecen, Hungary. DESIGN: Case series. METHODS: Subjective and objective accommodation measurements and pupillometry were performed in phakic and pseudophakic patients. Refraction and pupil diameter were recorded with different accommodation stimuli. Corneal higher-order aberrations (HOAs) and anterior chamber depths (ACDs) were detected with a rotating Scheimpflug camera. RESULTS: The mean age of the 44 patients in the phakic group was 36.34 years +/- 16.6 (SD) and of the 27 patients in the pseudophakic group, 69.3 +/- 9.98 years. The mean subjective accommodation was 4.49 +/- 3.48 diopters (D) in phakic eyes and showed significant correlation with age, spherical aberration, changes in pupil diameter, and ACD. The mean subjective accommodation was 0.50 +/- 0.28 D in pseudophakic eyes. In phakic eyes, the mean objective accommodation was 0.46 +/- 1.02 D, 1.06 +/- 1.33 D, and 2.2 +/- 1.9 D with 2.0 D, 3.0 D, and 5.0 D, respectively, of stimulus. In pseudophakic eyes, measurable objective accommodation was recorded. In phakic eyes, the correlations were significant between these values and age, changes in ACD, pupil size, and corneal spherical aberration. In pseudophakic eyes, the only correlation was with the spherical equivalent value. CONCLUSIONS: The magnitude of accommodation was greater with subjective measures than objective measures. In pseudophakic eyes, senile miosis and HOAs can be regarded as underlying factors in subjective accommodation; however, objective accommodation is not clinically significant.