Baseline Characteristics of the Infant Aphakia Treatment Study Population: Predicting Recognition Acuity at 4.5 Years of Age

Hartmann, E. Eugenie; Lynn, Michael; Lambert, Scott R.

doi:10.1167/iovs.14-15464

Cited by 43 publications

(22 citation statements)

References 18 publications

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“…Evaluation of the relationship between visual acuity at 4.5 years of age and age at surgery in IATS (28–48 vs. 49–210 days at surgery) revealed median visual acuity was significantly better for eyes operated younger vs. older (0.50 versus 1.10 logMAR, p=0.046). 31 Therefore, the desire to achieve maximum visual acuity must be counterbalanced against an increased risk of glaucoma or glaucoma suspect diagnosis in an infant with a unilateral congenital cataract.…”

Section: Discussionmentioning

confidence: 99%

Glaucoma-Related Adverse Events in the First 5 Years After Unilateral Cataract Removal in the Infant Aphakia Treatment Study

et al. 2015

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for the Infant Aphakia Treatment Study Group IMPORTANCE Glaucoma-related adverse events constitute major sight-threatening complications of cataract removal in infancy, yet their relationship to aphakia vs primary intraocular lens (IOL) implantation remains unsettled.OBJECTIVE To identify and characterize cases of glaucoma and glaucoma-related adverse events (glaucoma + glaucoma suspect) among children in the Infant Aphakia Treatment Study by the age of 5 years. DESIGN, SETTING, AND PARTICIPANTSA multicenter randomized clinical trial of 114 infants with unilateral congenital cataract in referral centers who were between ages 1 and 6 months at surgery. Mean follow-up was 4.8 years. This secondary analysis was conducted from December 23, 2004, to November 13, 2013.INTERVENTIONS Participants were randomized at cataract surgery to either primary IOL or no IOL implantation (contact lens). Standardized definitions of glaucoma and glaucoma suspect were created for the Infant Aphakia Treatment Study and applied for surveillance and diagnosis.MAIN OUTCOMES AND MEASURES Development of glaucoma and glaucoma + glaucoma suspect in operated on eyes for children up to age 5 years, plus intraocular pressure, visual acuity, and axial length at age 5 years.RESULTS Product limit estimates of the risk for glaucoma and glaucoma + glaucoma suspect at 4.8 years after surgery were 17% (95% CI, 11%-25%) and 31% (95% CI, 24%-41%), respectively. The contact lens and IOL groups were not significantly different for either outcome: glaucoma (hazard ratio [HR], 0.8; 95% CI, 0.3-2.0; P = .62) and glaucoma + glaucoma suspect (HR, 1.3; 95% CI, 0.6-2.5; P = .58). Younger (vs older) age at surgery conferred an increased risk for glaucoma (26% vs 9%, respectively) at 4.8 years after surgery (HR, 3.2; 95% CI, 1.2-8.3), and smaller (vs larger) corneal diameter showed an increased risk for glaucoma + glaucoma suspect (HR, 2.5; 95% CI, 1.3-5.0). Age and corneal diameter were significantly positively correlated. Glaucoma was predominantly open angle (19 of 20 cases, 95%), most eyes received medication (19 of 20, 95%), and 8 of 20 eyes (40%) underwent surgery.CONCLUSIONS AND RELEVANCE These results suggest that glaucoma-related adverse events are common and increase between ages 1 and 5 years in infants after unilateral cataract removal at 1 to 6 months of age; primary IOL placement does not mitigate their risk but surgery at a younger age increases the risk. Longer follow-up of these children may further characterize risk factors, long-term outcomes, potential differences between eyes having primary IOL vs aphakia, and optimal timing of unilateral congenital cataract removal. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00212134

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Section: Discussionmentioning

confidence: 99%

Glaucoma-Related Adverse Events in the First 5 Years After Unilateral Cataract Removal in the Infant Aphakia Treatment Study

et al. 2015

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“…In the Infant Aphakia Treatment Study (IATS), we found that socioeconomic status, measured by the availability of private insurance, and greater amounts of patching were the best predictors of a good visual acuity outcome. 7,8 However, neither variable accounted for 415% of the variance in visual outcomes.…”

Section: Introductionmentioning

confidence: 98%

Factors associated with stereopsis and a good visual acuity outcome among children in the Infant Aphakia Treatment Study

Lambert

DuBois

Cotsonis³

et al. 2016

Eye

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Purpose To identify factors associated with stereopsis in children with good visual acuity after unilateral congenital cataract surgery in the Infant Aphakia Treatment Study. Patients and methods Infants with a unilateral congenital cataract (n = 114) were randomized to IOL implantation or contact lens correction after cataract surgery. At age 4.5 years, a masked examiner assessed HOTV acuity and stereopsis. Adherence to patching was assessed using 48-h recall telephone interviews and 7-day diaries throughout the first 5 years of life. Ocular motility was evaluated at age 5 years. Baseline, postoperative, and adherence findings were compared between patients with 20/40 or better acuity in their treated eyes with or without stereopsis. Results Thirty (27%) of 112 patients who were evaluated at age 4.5 years had 20/40 or better acuity in their treated eye. Stereopsis was present on one or more tests in 15 of these 30 (50%) children. Baseline characteristics and postoperative findings did not differ between patients with or without stereopsis. Children with stereopsis were more likely to be orthotropic at distance (P = 0.003) and were patched for fewer hours per day throughout the first 5 years of life and the difference increased over time (Po0.001). On average children with stereopsis were patched for 3.4 h/day during the first year of life and patching steadily decreased to 1.8 h/day by age 4 years. Conclusion Among children with good vision following unilateral congenital cataract surgery, orthophoria and fewer hours of patching, particularly during years 2, 3, and 4, are associated with some evidence of stereopsis.

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“…Visual outcomes are often disappointing. Younger age at surgery is associated with better visual outcomes 5,6 . Unilateral cases have a worse visual prognosis in the affected eye than bilateral: at six years after surgery, a median visual acuity 0.48 in bilateral and 1.0 logMAR (affected eye) in unilateral cases has been reported 3 .…”

Section: Introductionmentioning

confidence: 99%

Quality of life and functional vision in children treated for cataract—a cross-sectional study

Tailor

Abou-Rayyah

Brookes

et al. 2017

Eye

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Baseline Characteristics of the Infant Aphakia Treatment Study Population: Predicting Recognition Acuity at 4.5 Years of Age

Cited by 43 publications

References 18 publications

Glaucoma-Related Adverse Events in the First 5 Years After Unilateral Cataract Removal in the Infant Aphakia Treatment Study

Glaucoma-Related Adverse Events in the First 5 Years After Unilateral Cataract Removal in the Infant Aphakia Treatment Study

Factors associated with stereopsis and a good visual acuity outcome among children in the Infant Aphakia Treatment Study

Quality of life and functional vision in children treated for cataract—a cross-sectional study

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