Chapter Fyodorov Gradiol: gradient refractive index optics multifocal IOL contains historical and actual information about gradient IOL – theoretical background, laboratory research, functional results of clinical studies and new approaches in the multifocal IOL’s assessment.
Currently available MIOLs have variable refractive power due to the complex shape of anterior and/or posterior surfaces; however, gradient refractive index multifocal lens (GRIN lens) is characterized by varying refractive power due to a change of refractive index in the inner structure of the IOL.
The main advantages of gradient IOL are the following: optics has smooth surfaces which define no need in lens surfaces orientation while implanting; at the same time it diminishes possibility of mechanical trauma, inner components, and surface damage in case of YAG-PCO treatment. It also provides possibility of low incidence of optical phenomena and good visual function at far, near, and intermediate distances under variable illuminance conditions.
The clinical study found high functional results and quality of vision after implantation of new generation Gradiol, high subjective satisfaction, and low incidence of optical phenomena.
Three months after implantation mean uncorrected distance VA was 0.90, mean uncorrected near VA 0.65, mean uncorrected intermediate VA 0.58, mean corrected distance VA 0.98, mean corrected near VA 0.84, and mean corrected intermediate VA 0.78. Mean amplitude of pseudoaccommodation was 4,75°D. Eighty-six percent of patients with Gradiol did not need glasses for daily activities, driving, and reading. Questionnaire revealed optical phenomena in post-op in 5%.
Gradient IOL GRIN lens Gradiol MIOL Multifocal IOL Cataract surgery
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Conflict of Interest
Boris Malyugin, Tatiana Morozova, and Valentin Cherednik have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
No animal studies were carried out by the authors for this chapter.
Chang DF. Prospective functional and clinical comparison of bilateral ReZoom and ReSTOR intraocular lenses in patients 70 years or younger. J Cataract Refract Surg. 2008;34:934–41.CrossRefGoogle Scholar
Cionni RJ, Osher RH, Snyder NE, Nordlund ML. Visual outcome comparison of unilateral versus bilateral implantation of apodized diffractive multifocal intraocular lens after cataract extraction: prospective 6–month study. J Cataract Refract Surg. 2009;35:1033–9.CrossRefGoogle Scholar
Alio JL, Pinero DP, AB P–P, Rodrigues Chan MJ. Visual outcomes and optical performance of a monofocal intraocular lens and a new–generation multifocal intraocular lens. J Cataract Refract Surg. 2011;37:241–50.CrossRefGoogle Scholar
Jain IS, Ram J, Bupta A. Early onset of presbyopia. Am J Optom Physiol Optic. 1982;59:1002–4.CrossRefGoogle Scholar
Fisher RF. The ciliary body in accommodation. Trans Ophthalmol Soc U K. 1986;105:208–19.PubMedGoogle Scholar
Beers AP, van der Heijde GL. Age-related changes in the accommodation mechanism. Optom Vis Sci. 1996;73:235–42.CrossRefGoogle Scholar
Strenk SA, Semmlow JL, Strenk LM, Munoz P, Gronlund–Jacob J, De Marco KJ. Age-related changes in human ciliary muscle and lens: a magnetic resonance imaging study. Invest Ophthalmol Vis Sci. 1999;40:1162–9.PubMedGoogle Scholar
Schachar RA. Cause and treatment of presbyopia with a method for increasing the amplitude of accommodation. Ann Ophthalmol. 1992;24:445–7, 452.PubMedGoogle Scholar
Schachar RA. Pathophysiology of accommodation and presbyopia: understanding the clinical implications. J Fla Med Assoc. 1994;81:268–71.PubMedGoogle Scholar
Schachar RA, Black TD, Kash RL, Cudmore DP, Schanzlin DJ. The mechanism of accommodation and presbyopia in the primate. Ann Ophthalmol. 1995;27:58–67.Google Scholar
Schachar RA. Is Helmholtz’s theory of accommodation correct? Ann Ophthalmol. 1999;31:10–7.Google Scholar
Glasser A. Can accommodation be surgically restored in human presbyopia? Optom Vis Sci. 1999;76:607–8.CrossRefGoogle Scholar
Glasser A. Thoughts on surgical correction of presbyopia. In: Refractive surgery: Theses of Subspecialty Day of AAO Annual Meeting. Dallas; 2000. p. 177–80.Google Scholar
Garner L, Ooi C, Smith G. Refractive index of the crystalline lens in young and aged eyes. Clin Exp Optom. 1998;81:145–50.CrossRefGoogle Scholar
Glasser A, Campbell MC. Presbyopia and the optical changes in the human crystalline lens with age. Vis Res. 1998;38:209–29.CrossRefGoogle Scholar
Pierscionek BK. Presbyopia–effect of refractive index. Clin ExpOptom. 1999;73:23–30.Google Scholar
Hamasaki D, Ong J, Marg E. The amplitude of accommodation in presbyopia. Am J Optom Arch Acad Optom. 1956;33:3–14.CrossRefGoogle Scholar
Milder B, Ruben ML. Accommodation. In: the fine art of prescribing glasses without making a spectacle of Gainesville: Triad Scientific Publishers; 1978. p. 18–41.Google Scholar
Steinberg EP, Tielsch JM, Schein OD, Javitt JC, Sharkey P, Cassard SD, et al. The VF–14. An index of functional impairment in patients with cataract. Arch Ophthalmol. 1994;112(5):630–8.CrossRefGoogle Scholar
Haring G, Dick HB, Krummenauer F, Weissmantel U, Kroncke W. Subjective photic phenomena with refractive multifocal and monofocal intraocular lenses. Results of a multicenter questionnaire. J Cataract Refract Surg. 2001;27:245–9.CrossRefGoogle Scholar
Takhtayev YV, Balashevich LI. Surgical correction of the hypermetropia and presbyopia by refractive–diffractive multifocal pseudoaccomodative IOLs AcrySof Restor. Ophthalmosurgery [Russian]. 2005;3:12–6.Google Scholar
Packard R. Lifestyle considerations for patients bilaterally implanted with a diffractive refractive intraocular lens: Long-term follow-up. Congress of the ESCRS, 24th: Abstracts. London; 2006. p. 113.Google Scholar
Dick HB. Experiens with the ReZoom IOL. J Cataract Refract Surg Today. 2005;6.Google Scholar
Pieh S, Weghaupt H, Skorpik C. Contrast sensitivity and glare disability with diffractive and refractive multifocal intraocular lenses. J Cataract Refract Surg. 1998;24:659–62.CrossRefGoogle Scholar
Javitt JC, Wang F, Trentacost DJ, Rowe M, Tarantino N. Outcomes of cataract extraction with multifocal intraocular lens implantation: functional status and quality of life. Ophthalmology. 1997;104:589–99.CrossRefGoogle Scholar
Sasaki A. Initial experience with a refractive multifocal intraocular lens in a Japanese population. J Cataract Refract Surg. 2000;26:1001–7.CrossRefGoogle Scholar