Evaluation of a satisfied bilateral scleral expansion band patient

To measure accommodation subjectively and objectively in a satisfied bilateral scleral expansion band patient.

University of Houston, College of Optometry, Houston, Texas, USA.

One bilateral scleral expansion patient (age 50 years), 9 age-matched normal presbyopic control subjects (age range 48 to 52 years), and 1 normal control subject (age 27 years) participated. The scleral expansion patient had a complete eye examination, corneal topography, and wavefront measurements 19 months postoperatively. Accommodation was measured subjectively with the push-up technique, minus to blur, and dioptric range of clear vision. Accommodation was determined objectively by measuring the accommodative responses to negative lenses and pilocarpine 6% with a Hartinger coincidence refractometer and to real targets with a dynamic infrared optometer.

Distance and near acuity of 20/20 was achieved with +1.00 diopter (D) in the left eye, +0.50 D in the right eye, and a near add of +2.25 D. Corneal topography and ocular aberration measurements revealed no suggestion of optical multifocality. Subjective measurements resulted in accommodative amplitudes of 1.50 to 4.00 D, and objective measurements resulted in amplitudes of 0.25 to 1.33 D. The PowerRefractor showed an accommodative response of 0.50 D to stimuli of 1.00 to 4.00 D and strong pupillary constriction with accommodative effort compared with the control.

No increase in accommodative amplitude above normal age-matched controls was found. Patient satisfaction may have come from the high expectations this patient had for a positive surgery outcome.