The report appears online today and will appear in the July print issue of Archives of Ophthalmology, a JAMA/Archives journal.
Since the 1970s, contact lenses have been the standard way of treating aphakia (surgical lens removal to treat cataract), according to background information in the article. “Their use during infancy, however, can be challenging owing to problems with insertion and removal of lenses by parents, lens loss, difficulties with fitting the steep corneas of infants and compliance problems,” the authors write. “These factors among others probably contribute to the poor visual outcome of many children with unilateral aphakia.”
According to David A. Plager, M.D., professor of ophthalmology and director of the Pediatric Ophthalmology and Adult Strabismus Service at Riley Hospital for Children, this is a landmark study to help guide clinicians as to the role of this modality in babies.
“We routinely use intra ocular lens implants in children down to age two years (at Riley Hospital for Children and nationally), but infants are much different,” Dr. Plager said. “This one year data shows that the IOL group did not do better or worse than the non-IOL group – but we may find that a difference becomes apparent as we continue to closely monitor the visual development of these children over the next several years.”
In recent years, the technology to surgically implant a lens directly into the eye (intraocular lens) has improved considerably, the authors note. Scott R. Lambert, M.D., of Emory Eye Center, Atlanta, and colleagues in the Infant Aphakia Treatment Study Group compared visual outcomes and adverse events among 114 infants (median or midpoint age at surgery, 1.8 months) randomly assigned to receive either an intraocular lens or contact lens after cataract surgery.
The rate of complications during surgery was 16 of 57 (28 percent) in the intraocular lens group and six of 57 (11 percent) in the contact lens group. At 1 year of age, visual acuity results did not differ between the two groups. However, more adverse events had occurred among children with intraocular lenses (44 or 77 percent vs. 14 or 25 percent), and these children were also five times more likely to undergo additional intraocular operations (36 or 63 percent compared with 7 or 12 percent).
“Thus, there appears to be no short-term visual benefit and some increased risk to implanting intraocular lenses in infants. However, since there remains a possibility that intraocular lenses may be found to be beneficial after a longer follow-up, we feel it would be premature to recommend that intraocular lenses not be implanted in infants,” the authors write.
“We suggest that practitioners continue to exercise caution when considering implanting intraocular lenses in infants,” they conclude. “The ultimate role for intraocular lens implantation during infancy may be further clarified after a longer follow-up with these children.”