Presbyopia, or the nearly universal age-related decline in accommodation, is a physiological process in which there is progressive loss of ability to focus on near targets.¹ Restoring accommodation in the pseudophakic patient is often regarded as the “holy grail” of cataract surgery. Many researchers and clinicians have dedicated their careers to developing ways to restore accommodation in the aging patient. This pursuit has led to a variety of innovations, ranging from the Phaco- Ersatz technique to accommodating intraocular lenses (IOLs).² 

Accommodating IOLs are lenses that aim to replicate the eye’s physiologic ability to shift focus seamlessly from distance to near, and vice versa.³ Many innovative designs have developed over the years, although with mixed clinical outcomes.

As of press time, the only FDA-approved accommodating lenses in the United States are Crystalens and Trulign Toric, both by Bausch + Lomb.^4,5 However, these lenses are not widely used. In Europe, the Lumina IOL (AkkoLens) recently received the CE mark and is available for implantation, with ongoing studies evaluating clinical outcomes.

Several accommodative lenses are currently under investigation, showcasing promising engineering strategies to restore a full range of vision in the pseudophakic patient. Following are overviews of each.

FluidVision (Alcon)

Originally developed by PowerVision, FluidVision is among the most studied of the newer accommodating IOLs. This hydrophobic acrylic lens is designed for capsular bag implantation and attempts to mimic natural accommodation by using a silicone fluid that can move between the optics and the haptics. When the ciliary muscle contracts during accommodation, the silicone fluid is squeezed from the haptics into the central optic, increasing the lens thickness and the optical power. In the relaxed state, the silicone fluid moves back into the haptics, reducing the thickness of the lens.⁶ 

A pilot study of 27 patients who received the FluidVision IOL monocularly reported a mean monocular best corrected distance vision of -0.05 logMAR at 6 months, with intermediate and near vision of 0.05 logMAR and 0.14 logMAR, respectively, and an average accommodative amplitude of 2.00 D, ranging up to 4.10 D.⁷ 

The ORION study, an ongoing multicenter clinical trial, compares the outcomes of the FluidVision lens system to those of the AcrySof IQ IOL (Alcon). Results have shown an objective amplitude of accommodation of up to 2.20 D, excellent distance- corrected intermediate and near vision, and comparable contrast sensitivity.⁶

Juvene (LensGen)

Juvene, currently undergoing clinical trials, is a novel, 2-piece silicone IOL system designed for placement in the capsular bag. It consists of a base lens with a clear central optic and a circumferential blue haptic, which is fixated into the capsular bag. Next, a fluid lens filled with silicone oil and fitted with a clear posterior optic and a flexible anterior curvature snaps into the base. It is thought that ciliary muscle contraction creates forces within the capsular bag that are then transmitted to the IOL system, altering the anterior curvature and the power of the lens.⁸ 

In 2022, 12-month data published by Sumitra Garg, MD, showed that among 51 eyes, the mean distance- corrected logMAR visual acuities for distance, intermediate, and near were 0.01, 0.08, and 0.24 respectively. Functional vision (defined as better than 20/40) was demonstrated in the defocus curve across a range of approximately +1.0 D to –2.0 D.⁸ 

More recently, 36-month data on 10 eyes, presented by Dr. Garg at the ASCRS 2023 meeting, showed promising outcomes with distance-corrected visual acuities of –0.06, 0.09, and 0.21 logMAR for distance, intermediate, and near, respectively. Improvement in vision was noted with binocular viewing. These results showed functional vision of 20/40 from +1.5 D to -2.5 D of defocus, along with improved contrast sensitivity and no reported adverse events.⁹ This lens also offers the potential advantage of exchanging the fluid lens if needed. 

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OmniVu (Atia Vision)

OmniVu is another promising lens on the horizon. It is a modular lens system comprising a hydrophobic, acrylic, fixed-power anterior optic and a posterior silicone-oil-filled silicone base that alters its shape based on ciliary muscle activity. During accommodation, the silicone fluid moves from the periphery to the center of the base, changing its curvature thickness and thus the power. The silicone oil-filled base is first implanted into the capsular bag, then the anterior optic is inserted and docked into the base.^10,11 

At the 2024 ASCRS Annual Meeting, George O. Waring IV, MD, presented the first 12-month human clinical data for OmniVu. A study of 25 eyes evaluated the safety and effectiveness of the OmniVu system for visual correction of aphakia and presbyopia after cataract surgery in adult patients. Mean uncorrected visual acuities for distance, intermediate, and near vision were 0.0, 0.06, and 0.23 logMAR, respectively, while distance-corrected visual acuities at the same distance were -0.06, 0.04, and 0.20 logMAR, with additional improvements observed binocularly. Binocular visual acuities of 20/32 and 20/40 were maintained across defocus ranges of 4.20 D and 5.00 D, respectively. 

The OmniVu has also shown a favorable contrast sensitivity profile and excellent safety record.¹⁰ Interestingly, since the optic is placed anteriorly in the OmniVu system, it can be replaced, allowing for refractive adjustments if the patient desires.

JelliSee IOL (JelliSee Ophthalmics)

JelliSee is designed to mimic the function of the pediatric crystalline lens, which is accommodated in its relaxed state.¹² It is composed of a flat, firm anterior surface with footplates (called actuators), which are attached directly to it. The actuators are placed peripherally in the capsular fornix, where they fibrose into place and can transfer zonular forces to the anterior firm surface in a manner similar to the natural capsule.^10,11 

Studies have demonstrated that the ciliary muscle can maintain its strength and function throughout life, exerting approximately 0.08 Newtons of force. The JelliSee lens  takes advantage of this force through 8 points of contact via the arcuator footplates. Increasing diopters of accommodation up to 7.00 D were described in primate models, as increasing fibrosis of the capsule stabilized the footplates. Early trials by John Vukich, MD, showed similar defocus curves between the JelliSee IOL and a healthy 10-year-old. In this lens system, the anterior surface remains identical across all lens powers, while the posterior optical element comes in spherical and toric powers. The next phase of clinical trials is currently underway.^10,11 

Opira (ForSight Vision6)

Opira is also characterized by a dual-component design. Unlike other accommodating IOLs, this is a silicone lens positioned in the sulcus, allowing for direct engagement with the ciliary body and thereby bypassing the capsular bag. The dual design features an anterior optic that responds dynamically to ciliary body contraction, causing a change in the power of the IOL; and a static posterior optic. The lens haptics are positioned within the capsulorhexis, so the size of the capsulorhexis must be precise.¹³

Data from 32 patients presented at Hawaiian Eye 2024 by David Chang, MD, showed excellent visual acuity results at distance, intermediate, and near, with spectacle independence noted in 97% of the patients.¹⁴ Data from ForSight Vision6, on a cohort of 29 patients who received the Opira lens in one eye and a standard monofocal lens in the fellow eye, reported better distance-corrected near and intermediate visual acuity in the eye with the Opira lens. Interestingly, questionnaire results showed that visual adverse effects such as glare and halos were lower compared to monofocal and trifocal lenses. No cases of uveitis-glaucoma- hyphema (UGH) syndrome or IOL dislocation or explantation have been reported.¹³ 

Lumina (AkkoLens)

Lumina is a CE-marked IOL available in Europe. A hydrophilic, acrylic lens, it is also designed for positioning in the sulcus, directly engaging with the ciliary body. It features 2 optical elements that can slide horizontally, relative to each other, in response to accommodation, adjusting the optical power, and shifting the focus. 

A recent phase 3 study of 25 patients who underwent bilateral implantation of the Lumina lens, pioneered by Dr. Jorge L Alió, reported 12-months data demonstrating significant improvements in uncorrected distance and near visual acuity to mean logMAR values of 0.06 and 0.27, respectively. For distance corrected visual acuity, the defocus curve showed values of -0.01±0.06 for distance, 0.18±0.11 for intermediate, and 0.38±0.13 for near. Mean objective accommodation measured –0.65 D, while the subjective depth of focus up was 3.63 D, indicating that the Lumina lens can offer both true and pseudo accommodation. The quality of vision remained high, contrast sensitivity exceeded normal values, and minimal photic phenomena were reported. Notably, up to 87% of patients reported no or mild difficulty with uncorrected near tasks.¹⁵

Conclusion

These lenses demonstrate that years of continuous research have brought us closer to restoring true physiologic vision. However, can a manufactured lens truly mimic the function of the human crystalline lens? Continued innovation, increased support for clinical trials, and long-term validation of clinical results will determine the answer. OM

References

1. Katz JA, Karpecki PM, Dorca A, et al. Presbyopia—a review of current treatment options and emerging therapies. Clin Ophthalmol. 2021;15:2167-2178. doi:10.2147/OPTH. S259011 

2. Parel JM, Gelender H, Trefers WF, Norton EW. Phaco-Ersatz: cataract surgery designed to preserve accommodation. Graefes Arch Clin Exp Ophthalmol. 1986;224(2):165-173. doi:10.1007/ BF02141492 

3. Pepose JS, Burke J, Qazi M. Accommodating intraocular lenses. Asia Pac J Ophthalmol (Phila). 2017;6(4):350-357. doi:10.22608/APO.2017198 

4. US Food and Drug Administration. Crystalens: Summary of Safety and Effectiveness Data. November 14, 2003. Accessed August 15, 2025. www.accessdata.fda.gov/cdrh_docs/pdf3/p030002b.pdf 

5. US Food and Drug Administration. Trulign Toric: Summary of Safety and Effectiveness Data. April 8, 2013. Accessed August 15, 2025. https://www.accessdata.fda.gov/cdrh_docs/pdf3/P030002S027b.pdf

6. Werner L. Accommodating IOLs: where are we now, and what’s on the horizon? Cataract & Refractive Surgery Today. February 2022. Accessed August 15, 2025. https://crstoday.com/articles/ feb-2022/accommodating-iols-where-are-we-now-and-whats-on-the-horizon

7. Nichamin L. Six-month pilot study with the next generation fluid-filled accommodating intraocular lens. Presented at: ESCRS annual meeting; September 24, 2018; Vienna, Austria.

8. Garg S, De Jesus MT, Fletcher LM, et al. Twelve-month clinical outcomes after implantation of a new, modular, anterior shape-changing fluid optic intraocular lens. J Cataract Refract Surg. 2022;48(10):1134-1140. doi:10.1097/j.jcrs.0000000000000935 

9. Crago SM, Stevenson S. ASCRS Live: 36-month outcomes for the Juvene modular intraocular lens. Ophthalmology Times. May 11, 2023. Accessed August 15, 2025. www.ophthalmologytimes.com/ view/ascrs-live-36-month-outcomes-for-the-juvene-modular-intraocular-lens

10. Waring GO, et al. 12-month safety and effectiveness outcomes of a novel, modular, shape-changing intraocular lens system. Presented at: 2024 ASCRS annual meeting; April 7, 2024; Boston, Massachusetts.

11. Garg S, Vukich J, Waring G). Update on accommodating IOLs. Cataract & Refractive Surgery Today. August 2024. Accessed August 15, 2025. https://crstoday.com/articles/aug-2024/ update-on-accommodating-iols

12. Shukla Y. Accommodative anomalies in children. Indian J Ophthalmol. 2020;68(8):1520-1525. doi:10.4103/ijo.IJO_1973_18 

13. Donnnenfeld E, Narain S. Get ready for truly accommodating lens implants. Ophthalmology Management. April 1, 2024. Accessed August 15, 2025. https://ophthalmologymanagement.com/issues/2024/april/get-ready-for-truly-accommodating-lens-implants/

14. Beers A. The journey to true accommodation. Review of Ophthalmology. April 4, 2024. Accessed August 15, 2025. https://www.reviewofophthalmology.com/article/the-journey-to-true-accommodation

15. Alió JL, Martínez-Abad A, Alió Del Barrio JL, Plaza-Puche MSc AB, Yebana P. One-year outcomes of the phase 3 clinical study on the Lumina accommodative intraocular lens. J Refract Surg. 2025;41(4):e374-e381. doi:10.3928/108159 7X-20250305-02

Despoina Theotoka, MD, MSc is an anterior segment fellow at Bascom Palmer Eye Institute in Plantation, Florida. She completed her ophthalmology residency at Yale University, where she was chief resident, and earned her master of science degree in vision science and investigative ophthalmology with honors from the University of Miami. She received her medical degree with honors from Pavol Jozef Safarik University in Košice, Slovakia. Dr. Theotoka has contributed multiple publications and presentations on ocular surface disease, corneal pathology, and advanced imaging techniques at national and international conferences.

Kendall E. Donaldson, MD, MS, is a corneal surgeon, a professor of clinical ophthalmology, and the medical director of Bascom Palmer Eye Institute’s new satellite campus in Sole Mia, Florida. Previously, she served as medical director for the Institute’s Plantation, Florida, campus. Dr. Donaldson’s primary research interests are advancements in cataract surgery, corneal transplant, severe ocular surface disease, and complex endothelial keratoplasty. She performs various types of corneal transplantation procedures, laser vision correction procedures, ocular surface reconstruction, and cataract surgery.